Provider Demographics
NPI:1417214602
Name:SCHAFFER, MARIA-CELINA FERNANDEZ
Entity Type:Individual
Prefix:
First Name:MARIA-CELINA
Middle Name:FERNANDEZ
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 LEIDICH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2530
Mailing Address - Country:US
Mailing Address - Phone:248-814-7374
Mailing Address - Fax:
Practice Address - Street 1:400 BROWN RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1305
Practice Address - Country:US
Practice Address - Phone:248-648-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist