Provider Demographics
NPI:1255302964
Name:SCHAEFER, MARY B (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:B
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11530 KENOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:49403-9402
Mailing Address - Country:US
Mailing Address - Phone:309-716-0250
Mailing Address - Fax:
Practice Address - Street 1:1309 S MISSION ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4207
Practice Address - Country:US
Practice Address - Phone:989-775-8051
Practice Address - Fax:989-779-0921
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist