Provider Demographics
NPI:1659725109
Name:SHAFFER, JOANN MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:MARIE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SAINT THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3831
Mailing Address - Country:US
Mailing Address - Phone:304-723-5109
Mailing Address - Fax:304-723-5125
Practice Address - Street 1:100 SAINT THOMAS DR
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3831
Practice Address - Country:US
Practice Address - Phone:304-723-5109
Practice Address - Fax:304-723-5125
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006427183500000X
OH03124214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist