Healthcare Provider Details

I. General information

NPI: 1790229672
Provider Name (Legal Business Name): JASON SCHAFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WALNUT ST STE 901
PHILADELPHIA PA
19107-5224
US

IV. Provider business mailing address

901 WALNUT ST STE 901
PHILADELPHIA PA
19107-5224
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-7522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP439372
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: