Provider Demographics
NPI:1083951032
Name:SCHROEDER, JEREMIAH FRANCIS
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:FRANCIS
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 1:11205 E STATE ROAD 70
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-9404
Mailing Address - Country:US
Mailing Address - Phone:941-727-4962
Mailing Address - Fax:941-758-5693
Practice Address - Street 1:11205 E STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-9404
Practice Address - Country:US
Practice Address - Phone:941-727-4962
Practice Address - Fax:941-758-5693
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist