Provider Demographics
NPI:1598245672
Name:SHEFFER, DEREK JAMES (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JAMES
Last Name:SHEFFER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2734
Mailing Address - Country:US
Mailing Address - Phone:607-729-1588
Mailing Address - Fax:
Practice Address - Street 1:37 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2734
Practice Address - Country:US
Practice Address - Phone:607-729-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY063036OtherNY STATE LICENSE