MEDICARE: MR. BENJAMIN DAVID SHAFFER RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03223604	OH

General Provider Information

NPI Number	:	1184605727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN DAVID SHAFFER RPH.

Provider Business Mailing Address
First Line	:	3421 FAIRWOOD DR
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2375
Country	:	US
Telephone Number	:	937-426-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 SOUTH EDWIN C. MOSES BLVD.
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45408
Country	:	US
Telephone Number	:	937-221-8067
Fax Number	:	937-221-8066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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