Provider Demographics
NPI:1043622350
Name:SHAFFER, MARCIA A (RPH)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:SHAFFER
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 1:4901 STATE ROAD 26 E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4611
Mailing Address - Country:US
Mailing Address - Phone:765-449-9233
Mailing Address - Fax:765-449-9265
Practice Address - Street 1:4901 STATE ROAD 26 E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4611
Practice Address - Country:US
Practice Address - Phone:765-449-9233
Practice Address - Fax:765-449-9265
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018391A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26018391AOtherPHARMACIST LICENSE