Healthcare Provider Details

I. General information

NPI: 1700938636
Provider Name (Legal Business Name): PAUL WILLIAM SCHAFFER R,PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 98TH ST
BLOOMINGTON MN
55420-4713
US

IV. Provider business mailing address

10408 ZION AVE S
BLOOMINGTON MN
55437-2731
US

V. Phone/Fax

Practice location:
  • Phone: 952-884-7528
  • Fax: 952-884-6366
Mailing address:
  • Phone: 952-881-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10950
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: