Provider Demographics
NPI:1801187604
Name:SCHMIDT, BRUCE DALE (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:DALE
Last Name:SCHMIDT
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 1:3558 RUFFIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2596
Mailing Address - Country:US
Mailing Address - Phone:858-627-5646
Mailing Address - Fax:858-627-5610
Practice Address - Street 1:3558 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2596
Practice Address - Country:US
Practice Address - Phone:858-627-5646
Practice Address - Fax:858-627-5610
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457330300Medicare UPIN