Healthcare Provider Details

I. General information

NPI: 1962778506
Provider Name (Legal Business Name): JARED THOMAS SCHMITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67-1185 MAMALOHOA HWY
KAMUELA HI
96743
US

IV. Provider business mailing address

67-1185 MAMALOHOA HWY
KAMUELA HI
96743
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-2075
  • Fax: 808-885-2061
Mailing address:
  • Phone: 808-885-2075
  • Fax: 808-885-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2982
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberSO13696
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: