Provider Demographics
NPI:1275831679
Name:SCHNEIDER, ERIC J
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
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 1:505 ROSEBUD PLZ
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9380
Mailing Address - Country:US
Mailing Address - Phone:304-622-6330
Mailing Address - Fax:304-622-9556
Practice Address - Street 1:505 ROSEBUD PLZ
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9380
Practice Address - Country:US
Practice Address - Phone:304-622-6330
Practice Address - Fax:304-622-9556
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist