MEDICARE: MR. DOUGLAS JOHN SCHARA 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	051038857	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R8595	OTHER	WI	PHARMACIST

General Provider Information

NPI Number	:	1710259494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS JOHN SCHARA RPH

Provider Business Mailing Address
First Line	:	5204 AMESBURY DR
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-3083
Country	:	US
Telephone Number	:	563-508-0741
Fax Number	:

Provider Business Practice Location Address
First Line	:	5204 AMESBURY DR
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807
Country	:	US
Telephone Number	:	563-508-0741
Fax Number	:

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

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/27/2012

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