Healthcare Provider Details

I. General information

NPI: 1609412733
Provider Name (Legal Business Name): WILLIAM J SHAFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 S BALDWIN RD
LAKE ORION MI
48359-1028
US

IV. Provider business mailing address

2658 PEBBLE BEACH DR
OAKLAND MI
48363-2449
US

V. Phone/Fax

Practice location:
  • Phone: 248-393-4573
  • Fax: 248-393-4583
Mailing address:
  • Phone: 248-229-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033095
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: