Provider Demographics
NPI:1730944505
Name:SHAFFFER, JACK HENRY (RPH)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:HENRY
Last Name:SHAFFFER
Suffix:
Gender:M
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 159
Mailing Address - Street 2:
Mailing Address - City:DONEGAL
Mailing Address - State:PA
Mailing Address - Zip Code:15628-0159
Mailing Address - Country:US
Mailing Address - Phone:724-593-2502
Mailing Address - Fax:724-593-7000
Practice Address - Street 1:181 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DONEGAL
Practice Address - State:PA
Practice Address - Zip Code:15628-0159
Practice Address - Country:US
Practice Address - Phone:724-593-2502
Practice Address - Fax:724-593-7000
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043337L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist