Provider Demographics
NPI:1366987430
Name:SHREFFLER, MARY ROSE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROSE
Last Name:SHREFFLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S COULTER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1712
Mailing Address - Country:US
Mailing Address - Phone:806-414-9074
Mailing Address - Fax:
Practice Address - Street 1:1300 S COULTER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1712
Practice Address - Country:US
Practice Address - Phone:806-414-9074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59024OtherTEXAS STATE BOARD OF PHARMACY