Healthcare Provider Details

I. General information

NPI: 1427105402
Provider Name (Legal Business Name): EDWARD CHARLES SCHUCH JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W COLUMBIA ST SUITE 2026
FARMINGTON MO
63640-2902
US

IV. Provider business mailing address

1010 W COLUMBIA ST SUITE 2026
FARMINGTON MO
63640-2902
US

V. Phone/Fax

Practice location:
  • Phone: 573-218-6756
  • Fax: 573-218-6762
Mailing address:
  • Phone: 573-218-6756
  • Fax: 573-218-6762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number027875
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: