Provider Demographics
NPI:1215372503
Name:SHAEFFER, JOSEPH CODY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CODY
Last Name:SHAEFFER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4611
Mailing Address - Country:US
Mailing Address - Phone:580-622-2208
Mailing Address - Fax:580-622-2212
Practice Address - Street 1:815 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4611
Practice Address - Country:US
Practice Address - Phone:580-622-2208
Practice Address - Fax:580-622-2212
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist