Provider Demographics
NPI:1518948454
Name:SHEFFLER, DWAYNE EARL
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:EARL
Last Name:SHEFFLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 BIRCH BANKS
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-8667
Mailing Address - Country:US
Mailing Address - Phone:208-263-8524
Mailing Address - Fax:
Practice Address - Street 1:1009 HIGHWAY 2
Practice Address - Street 2:WHITE CROSS PHARMACY
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2712
Practice Address - Country:US
Practice Address - Phone:208-263-9080
Practice Address - Fax:208-255-1695
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist