Provider Demographics
NPI:1548570849
Name:SCHELTEMA, DANIEL JERIK
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JERIK
Last Name:SCHELTEMA
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 1:49201 CRANBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1554
Mailing Address - Country:US
Mailing Address - Phone:586-506-6220
Mailing Address - Fax:
Practice Address - Street 1:40925 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-2537
Practice Address - Country:US
Practice Address - Phone:586-263-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist