MEDICARE: MS. MARY B SCHAEFER 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	5302030925	MI

General Provider Information

NPI Number	:	1255302964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY B SCHAEFER RPH

Provider Business Mailing Address
First Line	:	11530 KENOWA AVE
Second Line	:
City	:	CONKLIN
State	:	MI
Zip	:	49403-9402
Country	:	US
Telephone Number	:	309-716-0250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 S MISSION ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-4207
Country	:	US
Telephone Number	:	989-775-8051
Fax Number	:	989-779-0921

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/23/2012

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