Provider Demographics
NPI:1902151699
Name:SHAFFER, PAULA KAY (RPH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:SHAFFER
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:PO BOX 6464
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-6464
Mailing Address - Country:US
Mailing Address - Phone:208-914-5822
Mailing Address - Fax:208-726-1179
Practice Address - Street 1:201 N WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-914-5822
Practice Address - Fax:208-726-1179
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist