Provider Demographics
NPI:1619330123
Name:SHATTO, DAVID I JR (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:I
Last Name:SHATTO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 WOODRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057
Mailing Address - Country:US
Mailing Address - Phone:717-939-4349
Mailing Address - Fax:
Practice Address - Street 1:1581 WOODRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057
Practice Address - Country:US
Practice Address - Phone:717-939-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041624L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist