Provider Demographics
NPI:1033625017
Name:SCHMID, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SCHMID
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 1:40 CASA BELLA CIR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-1236
Mailing Address - Country:US
Mailing Address - Phone:847-977-9091
Mailing Address - Fax:
Practice Address - Street 1:291 W COCOA BEACH CSWY
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3529
Practice Address - Country:US
Practice Address - Phone:321-799-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS52947OtherPHARMACIST
FLPS52947Medicaid