Provider Demographics
NPI:1093317299
Name:SCHNEIDER, DEAN MELVIN
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:MELVIN
Last Name:SCHNEIDER
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 1:1239 CHICK AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2740
Mailing Address - Country:US
Mailing Address - Phone:660-541-0565
Mailing Address - Fax:
Practice Address - Street 1:1217 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2603
Practice Address - Country:US
Practice Address - Phone:660-582-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043032183500000X
IA16934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist