Healthcare Provider Details

I. General information

NPI: 1265062814
Provider Name (Legal Business Name): CLINT EDWARD SCHEIDLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N PATRICK BLVD STE 250
BROOKFIELD WI
53045-5854
US

IV. Provider business mailing address

3557 S 14TH ST
MILWAUKEE WI
53221-1639
US

V. Phone/Fax

Practice location:
  • Phone: 262-395-4658
  • Fax: 262-395-4664
Mailing address:
  • Phone: 219-863-6836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number15395-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: