Provider Demographics
NPI:1811296908
Name:SCHWARTZ, SHELLEY J (RPH)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:J
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E VIENNA ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1421
Mailing Address - Country:US
Mailing Address - Phone:810-687-0800
Mailing Address - Fax:810-687-6680
Practice Address - Street 1:100 E VIENNA ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1421
Practice Address - Country:US
Practice Address - Phone:810-687-0800
Practice Address - Fax:810-687-6680
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist