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General NPI Number Information
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NPI Number | 1780954289
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Entity Type | Individual
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Provider Name | BRIAN SCHULTZ
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Gender | Male
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Dates
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Enumeration Date | 12/31/2011
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | N2934 HWY 22 N
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City | WAUTOMA
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State | WI
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Zip | 54982
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Country | US
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Telephone | 920-787-5757
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Fax | 920-787-5382
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Provider Business Mailing Address
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Address Line | 250 CENTURY DR
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City | WAUTOMA
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State | WI
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Zip | 54982-7710
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Country | US
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Telephone | 706-669-8251
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Fax | 920-787-5382
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10723-40
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License Number State | WI
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