Healthcare Provider Details

I. General information

NPI: 1306333596
Provider Name (Legal Business Name): MICHAEL SCHULTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N5241 US HIGHWAY 45
WATERSMEET MI
49969-5115
US

IV. Provider business mailing address

PO BOX 9
WATERSMEET MI
49969-0009
US

V. Phone/Fax

Practice location:
  • Phone: 906-358-4587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038879
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: