Healthcare Provider Details

I. General information

NPI: 1326098872
Provider Name (Legal Business Name): MARK E SCHNEIDERHAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E 1ST ST
DULUTH MN
55805-2407
US

IV. Provider business mailing address

1401 E 1ST ST
DULUTH MN
55805-2407
US

V. Phone/Fax

Practice location:
  • Phone: 218-728-4491
  • Fax: 218-728-7970
Mailing address:
  • Phone: 218-728-4491
  • Fax: 218-728-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number15482-40
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number26015952A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number119660
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: