Provider Demographics
NPI:1255798690
Name:SHMIDT, VASILIKA
Entity type:Individual
Prefix:
First Name:VASILIKA
Middle Name:
Last Name:SHMIDT
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 1:4920 MAGNOLIA COVE DR
Mailing Address - Street 2:APT 4304
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2247
Mailing Address - Country:US
Mailing Address - Phone:347-733-7354
Mailing Address - Fax:
Practice Address - Street 1:8505 FM 1960 RD. WEST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:281-446-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist