Provider Demographics
NPI:1659962264
Name:SCHROEDER, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:SCHROEDER
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 1:535 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66523-1157
Mailing Address - Country:US
Mailing Address - Phone:785-528-4322
Mailing Address - Fax:785-528-3357
Practice Address - Street 1:535 MARKET ST
Practice Address - Street 2:
Practice Address - City:OSAGE CITY
Practice Address - State:KS
Practice Address - Zip Code:66523-1157
Practice Address - Country:US
Practice Address - Phone:785-528-4322
Practice Address - Fax:785-528-3357
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist