Provider Demographics
NPI:1154056539
Name:SCHULTZ, LAKE EMERSON (RPH)
Entity Type:Individual
Prefix:
First Name:LAKE
Middle Name:EMERSON
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66533-9782
Mailing Address - Country:US
Mailing Address - Phone:785-230-8290
Mailing Address - Fax:
Practice Address - Street 1:325 BLUEMONT AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5723
Practice Address - Country:US
Practice Address - Phone:785-776-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-107018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist