Provider Demographics
NPI:1235447590
Name:SHATTERLY, JEFFREY DALE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DALE
Last Name:SHATTERLY
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 1:600 CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-6504
Mailing Address - Country:US
Mailing Address - Phone:910-483-8972
Mailing Address - Fax:910-484-0607
Practice Address - Street 1:600 CEDAR CREEK RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-6504
Practice Address - Country:US
Practice Address - Phone:910-483-8972
Practice Address - Fax:910-484-0607
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist