Provider Demographics
NPI:1114093002
Name:SCHNORRENBERG, CHARLES REID (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:REID
Last Name:SCHNORRENBERG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:REID
Other - Middle Name:
Other - Last Name:SCHNORRENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:300 S HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448
Mailing Address - Country:US
Mailing Address - Phone:580-276-5349
Mailing Address - Fax:
Practice Address - Street 1:300 S HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448
Practice Address - Country:US
Practice Address - Phone:580-276-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8259OtherSTATE LICENSE NUMBER