Healthcare Provider Details

I. General information

NPI: 1689074171
Provider Name (Legal Business Name): MR. PETER MYTTHIAS SCHIRMER IV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PINEY RD
CHESTER MD
21619-2619
US

IV. Provider business mailing address

115 S PINEY RD
CHESTER MD
21619-2619
US

V. Phone/Fax

Practice location:
  • Phone: 410-643-3007
  • Fax: 410-643-4210
Mailing address:
  • Phone: 410-643-3007
  • Fax: 410-643-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17889
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: