Provider Demographics
NPI:1033457213
Name:SCHROEDER, STEVEN A
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18375 WILL O THE WISP WAY
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8884
Mailing Address - Country:US
Mailing Address - Phone:719-649-2868
Mailing Address - Fax:
Practice Address - Street 1:18375 WILL O THE WISP WAY
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8884
Practice Address - Country:US
Practice Address - Phone:719-649-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist