MEDICARE: MR. KENNETH HARRY SCHMIDT 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	042293-1	NY

General Provider Information

NPI Number	:	1700091147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH HARRY SCHMIDT RPH

Provider Business Mailing Address
First Line	:	40 KIRSCHMAN DR
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-6670
Country	:	US
Telephone Number	:	732-566-4373
Fax Number	:

Provider Business Practice Location Address
First Line	:	5756 HARTFORD ROAD
Second Line	:
City	:	FORT DIX
State	:	NJ
Zip	:	08640
Country	:	US
Telephone Number	:	609-723-1100
Fax Number	:

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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