Provider Demographics
NPI:1659471571
Name:SCHULTZ, JUDY CAROL BECK (RPH)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:CAROL BECK
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 LAWTON STREET
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1816
Mailing Address - Country:US
Mailing Address - Phone:517-676-7691
Mailing Address - Fax:517-699-8291
Practice Address - Street 1:2380 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2143
Practice Address - Country:US
Practice Address - Phone:517-669-8290
Practice Address - Fax:517-669-8291
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-13180183500000X
MI5302031359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist