Provider Demographics
NPI:1962497859
Name:SHAFFER, CATHY L (DPH, MPH)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:DPH, MPH
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:L
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPH, MPH
Mailing Address - Street 1:715 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-3201
Mailing Address - Country:US
Mailing Address - Phone:981-287-4491
Mailing Address - Fax:917-287-2347
Practice Address - Street 1:715 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-3201
Practice Address - Country:US
Practice Address - Phone:981-287-4491
Practice Address - Fax:917-287-2347
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90241835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9024OtherPHARMACY LICENSE #