Healthcare Provider Details

I. General information

NPI: 1659962264
Provider Name (Legal Business Name): MIKE SCHROEDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MARKET ST
OSAGE CITY KS
66523-1157
US

IV. Provider business mailing address

535 MARKET ST
OSAGE CITY KS
66523-1157
US

V. Phone/Fax

Practice location:
  • Phone: 785-528-4322
  • Fax: 785-528-3357
Mailing address:
  • Phone: 785-528-4322
  • Fax: 785-528-3357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13999
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: