MEDICARE: DAVID HERBERT SCHUG BS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302410441	MI

General Provider Information

NPI Number	:	1063572840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HERBERT SCHUG BS RPH

Provider Business Mailing Address
First Line	:	4274 OAK ST.
Second Line	:	P.O. BOX 732
City	:	BRIDGMAN
State	:	MI
Zip	:	49106
Country	:	US
Telephone Number	:	269-465-3217
Fax Number	:	269-465-3204

Provider Business Practice Location Address
First Line	:	612 SAINT JOSEPH AVE
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1603
Country	:	US
Telephone Number	:	269-471-5020
Fax Number	:	269-473-2566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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