Provider Demographics
NPI:1407949837
Name:SHAFFER PHARMACY INC
Entity Type:Organization
Organization Name:SHAFFER PHARMACY INC
Other - Org Name:SHAFFER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMD
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:419-473-0891
Mailing Address - Street 1:3900 SUNFOREST CT STE 124
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4476
Mailing Address - Country:US
Mailing Address - Phone:419-473-0891
Mailing Address - Fax:419-473-0899
Practice Address - Street 1:3900 SUNFOREST CT STE 124
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4476
Practice Address - Country:US
Practice Address - Phone:419-473-0891
Practice Address - Fax:419-473-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
OH020157850033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0765337Medicaid
2075582OtherPK
2075582OtherPK