Provider Demographics
NPI:1285454652
Name:SHAFER, KYLE TAYLOR (PHARMACIST)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:TAYLOR
Last Name:SHAFER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OLIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-1527
Mailing Address - Country:US
Mailing Address - Phone:814-440-1601
Mailing Address - Fax:
Practice Address - Street 1:410 E 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1226
Practice Address - Country:US
Practice Address - Phone:814-456-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist