Provider Demographics
NPI:1235134826
Name:SHAFER, ROD (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROD
Middle Name:
Last Name:SHAFER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 N HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2519
Mailing Address - Country:US
Mailing Address - Phone:916-802-9666
Mailing Address - Fax:
Practice Address - Street 1:435 S ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2305
Practice Address - Country:US
Practice Address - Phone:480-380-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010359183500000X
AZS018200183500000X
TX49642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist