Provider Demographics
NPI:1689010563
Name:SCHULTZ, KEVIN L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1104
Mailing Address - Country:US
Mailing Address - Phone:920-722-1895
Mailing Address - Fax:920-722-3195
Practice Address - Street 1:1578 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1104
Practice Address - Country:US
Practice Address - Phone:920-722-1895
Practice Address - Fax:920-722-3195
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13436-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist