Provider Demographics
NPI:1013444363
Name:SHOFFNER, WILLIAM ERIC
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ERIC
Last Name:SHOFFNER
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 1:1117 MCLAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3545
Mailing Address - Country:US
Mailing Address - Phone:870-523-5555
Mailing Address - Fax:870-523-6337
Practice Address - Street 1:1117 MCLAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112
Practice Address - Country:US
Practice Address - Phone:870-523-5555
Practice Address - Fax:870-523-6337
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780120691OtherNPI