Healthcare Provider Details

I. General information

NPI: 1912112525
Provider Name (Legal Business Name): DOUGLAS WAYNE SHAFER R.PH., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W NOYES ST
ARLINGTON HEIGHTS IL
60005-3745
US

IV. Provider business mailing address

15 W NOYES ST
ARLINGTON HEIGHTS IL
60005-3745
US

V. Phone/Fax

Practice location:
  • Phone: 847-364-9664
  • Fax: 847-364-6346
Mailing address:
  • Phone: 847-364-9664
  • Fax: 847-364-6346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: