Provider Demographics
NPI:1750446191
Name:DAVID K & ELLEN SCHMITZ, INC
Entity Type:Organization
Organization Name:DAVID K & ELLEN SCHMITZ, INC
Other - Org Name:SCHMITZ'S ECONOMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TELLEFSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:715-635-8785
Mailing Address - Street 1:700 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-9692
Mailing Address - Country:US
Mailing Address - Phone:715-635-8785
Mailing Address - Fax:715-635-2637
Practice Address - Street 1:700 S RIVER ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-9692
Practice Address - Country:US
Practice Address - Phone:715-635-8785
Practice Address - Fax:715-635-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33179000Medicaid
WI4436530001Medicare NSC