Provider Demographics
NPI:1407459092
Name:SCHROEDER, EDWIN WILLIAM JR
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:WILLIAM
Last Name:SCHROEDER
Suffix:JR
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 1:1590 DUNLAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4752
Mailing Address - Country:US
Mailing Address - Phone:386-761-0191
Mailing Address - Fax:
Practice Address - Street 1:1590 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4752
Practice Address - Country:US
Practice Address - Phone:386-761-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist