Provider Demographics
NPI:1629315577
Name:SCAFFE, JEFFREY STUART (R PH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STUART
Last Name:SCAFFE
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4274 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3070
Mailing Address - Country:US
Mailing Address - Phone:706-650-5046
Mailing Address - Fax:706-650-5055
Practice Address - Street 1:4274 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3070
Practice Address - Country:US
Practice Address - Phone:706-650-5046
Practice Address - Fax:706-650-5055
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist