Provider Demographics
NPI:1982995163
Name:SCHACKOW, DAVID M SR (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SCHACKOW
Suffix:SR
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 1:54874 KRISTI LN
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-9237
Mailing Address - Country:US
Mailing Address - Phone:574-674-4217
Mailing Address - Fax:
Practice Address - Street 1:11 S 11TH ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2757
Practice Address - Country:US
Practice Address - Phone:269-684-6556
Practice Address - Fax:269-687-6365
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist