Provider Demographics
NPI:1275815649
Name:SHAFFER, LESLIE ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANNE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:SCHNACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3601 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7259
Mailing Address - Country:US
Mailing Address - Phone:309-743-0269
Mailing Address - Fax:
Practice Address - Street 1:3601 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7259
Practice Address - Country:US
Practice Address - Phone:309-743-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21221183500000X
IL294270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist