Provider Demographics
NPI:1689074171
Name:SCHIRMER, PETER MYTTHIAS IV
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:MYTTHIAS
Last Name:SCHIRMER
Suffix:IV
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 1:115 S PINEY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2619
Mailing Address - Country:US
Mailing Address - Phone:410-643-3007
Mailing Address - Fax:410-643-4210
Practice Address - Street 1:115 S PINEY RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2619
Practice Address - Country:US
Practice Address - Phone:410-643-3007
Practice Address - Fax:410-643-4210
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist