Provider Demographics
NPI:1174660302
Name:SHAFFER, LORRAINE E (RPH)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:E
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 1:939 W GUNNISON ST
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:939 W GUNNISON ST
Practice Address - Street 2:SUITE 3E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4234
Practice Address - Country:US
Practice Address - Phone:773-459-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist