Provider Demographics
NPI:1760816359
Name:SCHELLINGER, TIM (RPH)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:SCHELLINGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S MAINLINE DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-1150
Mailing Address - Country:US
Mailing Address - Phone:920-833-2141
Mailing Address - Fax:
Practice Address - Street 1:1010 S MAINLINE DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:WI
Practice Address - Zip Code:54165-1150
Practice Address - Country:US
Practice Address - Phone:920-833-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist