Provider Demographics
NPI:1457130502
Name:SHIFFLETT, PATRICK JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:SHIFFLETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37088 W FENWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3878
Mailing Address - Country:US
Mailing Address - Phone:302-436-7191
Mailing Address - Fax:
Practice Address - Street 1:37088 W FENWICK BLVD
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-3878
Practice Address - Country:US
Practice Address - Phone:302-436-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0015962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist