MEDICARE: MS. CONNIE L SHAFER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00010295	WA

General Provider Information

NPI Number	:	1104813112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONNIE L SHAFER RPH

Provider Business Mailing Address
First Line	:	134 NE 63RD ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-6537
Country	:	US
Telephone Number	:	206-524-4365
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 EASTLAKE AVE E
Second Line	:	SUITE 405
City	:	SEATTLE
State	:	WA
Zip	:	98102-3345
Country	:	US
Telephone Number	:	206-448-6275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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