Provider Demographics
NPI:1164415980
Name:SCHOENDORF, MIKE MEADE (RPH)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:MEADE
Last Name:SCHOENDORF
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 1:912 SUSSEX CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:E DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027-7414
Practice Address - Country:US
Practice Address - Phone:478-272-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist