Healthcare Provider Details

I. General information

NPI: 1942583281
Provider Name (Legal Business Name): TERESA LEA SHAFFER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 FOREST GROVE DR NE
GEORGETOWN IN
47122-7764
US

IV. Provider business mailing address

6310 FOREST GROVE DR NE
GEORGETOWN IN
47122-7764
US

V. Phone/Fax

Practice location:
  • Phone: 812-366-3369
  • Fax:
Mailing address:
  • Phone: 812-366-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26018941A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: