Provider Demographics
NPI:1265062814
Name:SCHEIDLER, CLINT EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:EDWARD
Last Name:SCHEIDLER
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 1:3557 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-1639
Mailing Address - Country:US
Mailing Address - Phone:219-863-6836
Mailing Address - Fax:
Practice Address - Street 1:150 N PATRICK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5854
Practice Address - Country:US
Practice Address - Phone:262-395-4658
Practice Address - Fax:262-395-4664
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15395-401835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528469988Medicaid