Provider Demographics
NPI:1851992564
Name:SCHULTHEIS, MAUREEN WEISMANN
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:WEISMANN
Last Name:SCHULTHEIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 STONE RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1618
Mailing Address - Country:US
Mailing Address - Phone:703-803-8556
Mailing Address - Fax:844-411-6502
Practice Address - Street 1:5615 STONE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1618
Practice Address - Country:US
Practice Address - Phone:703-803-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist