Provider Demographics
NPI:1992309132
Name:SHORTMAN, CAROLYN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SHORTMAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SMITH PL APT 3
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-7203
Mailing Address - Country:US
Mailing Address - Phone:330-607-6914
Mailing Address - Fax:
Practice Address - Street 1:8100 E BROAD ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8019
Practice Address - Country:US
Practice Address - Phone:614-322-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019914183500000X
OH03337177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist