Provider Demographics
NPI:1447027180
Name:SOFTY, SHANE JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:JOSEPH
Last Name:SOFTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10436 ST JUST RD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22567-3502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10001 SOUTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2700
Practice Address - Country:US
Practice Address - Phone:540-834-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist