MEDICARE: SYBILLE SCHELLACK

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	114340	KS

General Provider Information

NPI Number	:	1891049920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYBILLE SCHELLACK

Provider Business Mailing Address
First Line	:	2229 S MAIN ST
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-3023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2229 S MAIN ST
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-3023
Country	:	US
Telephone Number	:	620-223-2402
Fax Number	:	620-223-4921

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

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	10/26/2012

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Directions to “ SYBILLE SCHELLACK ” Practice Location

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