Provider Demographics
NPI:1104111723
Name:SHEFFER, PHUONG VO (RPH)
Entity type:Individual
Prefix:MR
First Name:PHUONG
Middle Name:VO
Last Name:SHEFFER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 W GILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0499
Mailing Address - Country:US
Mailing Address - Phone:801-897-2706
Mailing Address - Fax:
Practice Address - Street 1:404 S 400 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2201
Practice Address - Country:US
Practice Address - Phone:801-364-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT151839-1701183500000X
NV10711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist