Provider Demographics
NPI:1760043442
Name:SCHNEIDER, HERBERT BERNARD
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:BERNARD
Last Name:SCHNEIDER
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 1:1815 LAKE QUITMAN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-8079
Mailing Address - Country:US
Mailing Address - Phone:832-250-7105
Mailing Address - Fax:
Practice Address - Street 1:800 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-5324
Practice Address - Country:US
Practice Address - Phone:281-471-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist