Provider Demographics
NPI:1821278250
Name:SCHAFFER, KEVIN JON (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JON
Last Name:SCHAFFER
Suffix:
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 1:226 RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5941
Mailing Address - Country:US
Mailing Address - Phone:315-733-8368
Mailing Address - Fax:
Practice Address - Street 1:2308 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1746
Practice Address - Country:US
Practice Address - Phone:315-624-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031029-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist