Healthcare Provider Details

I. General information

NPI: 1194038042
Provider Name (Legal Business Name): CLAUDIA KOHLERT-SCHUPP PHD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 S MARINE CORPS DR FHP HEALTH CENTER
TAMUNING GU
96913-3539
US

IV. Provider business mailing address

548 S MARINE CORPS DR FHP HEALTH CENTER
TAMUNING GU
96913-3539
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-5825
  • Fax: 671-647-3598
Mailing address:
  • Phone: 671-646-5825
  • Fax: 671-647-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60020056
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH0152
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: