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General NPI Number Information
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NPI Number | 1285454652
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Entity Type | Individual
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Provider Name | KYLE TAYLOR SHAFER PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 410 E 12TH ST
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City | ERIE
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State | PA
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Zip | 16503-1226
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Country | US
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Telephone | 814-456-7071
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Fax |
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Provider Business Mailing Address
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Address Line | 109 OLIN AVE APT 1
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City | GIRARD
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State | PA
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Zip | 16417-1527
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Country | US
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Telephone | 814-440-1601
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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 | RP458994
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License Number State | PA
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