Provider Demographics
NPI:1013062066
Name:SHOFF, SHARON (RPH)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SHOFF
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 1:233 BURKEY DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-7505
Mailing Address - Country:US
Mailing Address - Phone:814-736-4325
Mailing Address - Fax:814-736-9522
Practice Address - Street 1:619 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-1539
Practice Address - Country:US
Practice Address - Phone:814-736-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031302L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007331830002Medicaid