Healthcare Provider Details

I. General information

NPI: 1962842138
Provider Name (Legal Business Name): CHARLES KENNETH SCHMID DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E CHARLES PAGE BLVD
SAND SPRINGS OK
74063-8505
US

IV. Provider business mailing address

4130 E 38TH ST
TULSA OK
74135
US

V. Phone/Fax

Practice location:
  • Phone: 918-245-6868
  • Fax: 918-241-4325
Mailing address:
  • Phone: 918-744-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11157
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: