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General NPI Number Information
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NPI Number | 1275815649
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Entity Type | Individual
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Provider Name | LESLIE ANNE SHAFFER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 3601 16TH ST
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City | MOLINE
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State | IL
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Zip | 61265-7259
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Country | US
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Telephone | 309-743-0269
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 16TH ST
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City | MOLINE
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State | IL
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Zip | 61265-7259
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Country | US
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Telephone | 309-743-0269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21221
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 294270
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License Number State | IL
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