Provider Demographics
NPI:1154997815
Name:TRAUTZ SHUMSKY, DEBORAH (RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:TRAUTZ SHUMSKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1254
Mailing Address - Country:US
Mailing Address - Phone:610-645-4848
Mailing Address - Fax:267-487-8978
Practice Address - Street 1:1414 S PENN SQ UNIT 9F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2546
Practice Address - Country:US
Practice Address - Phone:215-694-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4811679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist