Provider Demographics
NPI:1811999345
Name:SHAFFER, VIVIEN C (RN, PHARM D)
Entity type:Individual
Prefix:DR
First Name:VIVIEN
Middle Name:C
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RN, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 WEST NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:HARROD
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2457
Mailing Address - Country:US
Mailing Address - Phone:419-648-3320
Mailing Address - Fax:
Practice Address - Street 1:959 WEST NORTH STREET
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2457
Practice Address - Country:US
Practice Address - Phone:419-226-9597
Practice Address - Fax:419-226-4363
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.150303163W00000X
OH03-1-20831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163W00000XNursing Service ProvidersRegistered Nurse