Provider Demographics
NPI:1447548359
Name:SCHAFFENACKER, NICOLE RENEE (RPH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:SCHAFFENACKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LAMPLIGHTER CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PULASKI
Mailing Address - State:IL
Mailing Address - Zip Code:62548-6060
Mailing Address - Country:US
Mailing Address - Phone:217-732-1825
Mailing Address - Fax:217-732-7796
Practice Address - Street 1:603 WOODLAWN RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1406
Practice Address - Country:US
Practice Address - Phone:217-732-1825
Practice Address - Fax:217-732-7796
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512900931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist