Provider Demographics
NPI:1720379209
Name:SHOTZBARGER, ALAN DALE
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DALE
Last Name:SHOTZBARGER
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 1:3871 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3058
Mailing Address - Country:US
Mailing Address - Phone:330-220-7767
Mailing Address - Fax:
Practice Address - Street 1:3871 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3058
Practice Address - Country:US
Practice Address - Phone:330-220-7767
Practice Address - Fax:330-220-9789
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist