Provider Demographics
NPI:1376699603
Name:SHAFER DRUG STORE
Entity Type:Organization
Organization Name:SHAFER DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:ZABLOTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-467-4200
Mailing Address - Street 1:1328 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1708
Mailing Address - Country:US
Mailing Address - Phone:814-467-4200
Mailing Address - Fax:814-467-7412
Practice Address - Street 1:1328 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1708
Practice Address - Country:US
Practice Address - Phone:814-467-4200
Practice Address - Fax:814-467-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412249L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3928150OtherNCPDP NUMBER
PA0005846520001Medicaid
PA0005846520001Medicaid