Provider Demographics
NPI:1861636748
Name:SCHROEDER, RAYMOND SCOTT (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:SCOTT
Last Name:SCHROEDER
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 1:215 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1109
Mailing Address - Country:US
Mailing Address - Phone:563-324-1960
Mailing Address - Fax:563-324-3305
Practice Address - Street 1:2151 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3628
Practice Address - Country:US
Practice Address - Phone:563-324-5004
Practice Address - Fax:563-324-3305
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist