Provider Demographics
NPI:1053842187
Name:SCHULTZ, DOUGLAS DONALD (RPH, HIS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:DONALD
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:RPH, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 BROWN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2491
Mailing Address - Country:US
Mailing Address - Phone:262-567-6651
Mailing Address - Fax:262-567-5028
Practice Address - Street 1:1260 BROWN ST
Practice Address - Street 2:SUITE A
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2491
Practice Address - Country:US
Practice Address - Phone:262-567-6651
Practice Address - Fax:262-567-5028
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8744-40183500000X
WI305237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No183500000XPharmacy Service ProvidersPharmacist