Provider Demographics
NPI:1245902394
Name:SCHMIDT, AMY LOUISE-IVERSEN (CPHT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE-IVERSEN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:IVERSEN-SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPHT
Mailing Address - Street 1:3903 S STONE RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-7639
Mailing Address - Country:US
Mailing Address - Phone:616-502-3777
Mailing Address - Fax:
Practice Address - Street 1:14700 US 31
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8390
Practice Address - Country:US
Practice Address - Phone:616-844-4184
Practice Address - Fax:616-844-4189
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303003384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist