Provider Demographics
NPI:1972942498
Name:SCHMIDGALL, JOHN HENRY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:SCHMIDGALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 ATLANTIC AVE
Mailing Address - Street 2:PO BOX 268
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-4728
Mailing Address - Country:US
Mailing Address - Phone:320-589-1100
Mailing Address - Fax:
Practice Address - Street 1:618 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-4728
Practice Address - Country:US
Practice Address - Phone:320-589-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist