Provider Demographics
NPI:1942583281
Name:SHAFFER, TERESA LEA (RPH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LEA
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 FOREST GROVE DR NE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-7764
Mailing Address - Country:US
Mailing Address - Phone:812-366-3369
Mailing Address - Fax:
Practice Address - Street 1:6310 FOREST GROVE DR NE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-7764
Practice Address - Country:US
Practice Address - Phone:812-366-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018941A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist