Provider Demographics
NPI:1154802809
Name:SHAFFER, ROBERT N (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:SHAFFER
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 1:1628 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-4922
Mailing Address - Country:US
Mailing Address - Phone:610-797-1063
Mailing Address - Fax:
Practice Address - Street 1:1628 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4922
Practice Address - Country:US
Practice Address - Phone:610-797-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037667L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP037667LOtherPA RPH STATE LICENSE NUMBER
PARPI012087OtherPA AUTH. TO ADMINISTER INJECTABLES