Provider Demographics
NPI:1376203844
Name:SCHORNHEUSER, COLE
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:SCHORNHEUSER
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 1:308 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3602
Mailing Address - Country:US
Mailing Address - Phone:314-651-3037
Mailing Address - Fax:
Practice Address - Street 1:705 E BRIGGS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1906
Practice Address - Country:US
Practice Address - Phone:660-385-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021046240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist