Provider Demographics
NPI:1093013054
Name:SCHNEIDER, MARK A
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:R PH
Mailing Address - Street 1:9055 SHOAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4072
Mailing Address - Country:US
Mailing Address - Phone:850-907-9386
Mailing Address - Fax:
Practice Address - Street 1:9055 SHOAL CREEK DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-4072
Practice Address - Country:US
Practice Address - Phone:850-907-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0018533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist