Provider Demographics
NPI:1669008041
Name:SCHUCK, BRIAN C (RPH; PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:SCHUCK
Suffix:
Gender:M
Credentials:RPH; PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16291 OUTBACK DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16291 OUTBACK DR
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8819
Practice Address - Country:US
Practice Address - Phone:616-723-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315103079183500000X
IN26020794A183500000X
MI5302032340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist