Provider Demographics
NPI:1023151453
Name:SHETTER, DAVID DOSCH
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DOSCH
Last Name:SHETTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 FALLING SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-8566
Mailing Address - Country:US
Mailing Address - Phone:717-658-3080
Mailing Address - Fax:
Practice Address - Street 1:214 PEACH ORCHARD RD STE 100
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8559
Practice Address - Country:US
Practice Address - Phone:717-485-3622
Practice Address - Fax:717-485-5176
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034010R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011371360002Medicaid
PA0011371360003Medicaid
PA0011371360002Medicaid