Provider Demographics
NPI:1346523560
Name:SCHIMIZZI, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SCHIMIZZI
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 1:56199 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-9519
Mailing Address - Country:US
Mailing Address - Phone:574-674-9253
Mailing Address - Fax:
Practice Address - Street 1:56199 BIRCH RD
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-9519
Practice Address - Country:US
Practice Address - Phone:574-674-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26012410OtherLICENSE NUMBER