Healthcare Provider Details

I. General information

NPI: 1174967335
Provider Name (Legal Business Name): CRAIG J SCHAEFER CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 812
LOS ANGELES CA
90069-3709
US

IV. Provider business mailing address

9201 W SUNSET BLVD STE 812
LOS ANGELES CA
90069-3709
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-1010
  • Fax:
Mailing address:
  • Phone: 310-550-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number165564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: