Healthcare Provider Details

I. General information

NPI: 1487309977
Provider Name (Legal Business Name): JOESPH THOMAS SCHEBAUM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/23/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 HIGHWAY NN
HERMANN MO
65041-4912
US

IV. Provider business mailing address

195 HWY 100 WEST
HERMANN MO
65041-4912
US

V. Phone/Fax

Practice location:
  • Phone: 314-605-3601
  • Fax:
Mailing address:
  • Phone: 573-486-2873
  • Fax: 573-486-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019025994
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: