Provider Demographics
NPI:1295367118
Name:SCHULTZ, CALEB JAMES
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:JAMES
Last Name:SCHULTZ
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 1:1925 MARKETPLACE DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8511
Mailing Address - Country:US
Mailing Address - Phone:616-698-1186
Mailing Address - Fax:
Practice Address - Street 1:1925 MARKETPLACE DR SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-8511
Practice Address - Country:US
Practice Address - Phone:616-698-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist