Provider Demographics
NPI:1518973619
Name:SCHMIDT, DALE
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:SCHMIDT
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 1:231 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3576
Mailing Address - Country:US
Mailing Address - Phone:715-229-2074
Mailing Address - Fax:
Practice Address - Street 1:514 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:WITHEE
Practice Address - State:WI
Practice Address - Zip Code:54498
Practice Address - Country:US
Practice Address - Phone:715-229-2074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10390-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10390-040OtherPHARMACIST LICENSE