Provider Demographics
NPI:1801178595
Name:SCHMALE, ALYSSA M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:M
Last Name:SCHMALE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SWEETBAY RD
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-4244
Mailing Address - Country:US
Mailing Address - Phone:618-534-6273
Mailing Address - Fax:
Practice Address - Street 1:1 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1025
Practice Address - Country:US
Practice Address - Phone:618-357-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist