Healthcare Provider Details

I. General information

NPI: 1306329529
Provider Name (Legal Business Name): BROOKLYN SHAFFER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 US HIGHWAY 93 S
WHITEFISH MT
59937-8282
US

IV. Provider business mailing address

6475 US HIGHWAY 93 S
WHITEFISH MT
59937-8282
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-7434
  • Fax: 406-862-7432
Mailing address:
  • Phone: 406-862-7434
  • Fax: 406-862-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54635
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: