Provider Demographics
NPI:1700384138
Name:SCHALO, JACK MICHAEL
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:MICHAEL
Last Name:SCHALO
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 1:8446 CROWN WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-9545
Mailing Address - Country:US
Mailing Address - Phone:530-515-8447
Mailing Address - Fax:530-244-0961
Practice Address - Street 1:1060 E CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1114
Practice Address - Country:US
Practice Address - Phone:530-221-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist