Provider Demographics
NPI:1093825747
Name:SCHWARTZ, HERBERT JACK (RPH)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:JACK
Last Name:SCHWARTZ
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 1:399 LAKEVIEW DR
Mailing Address - Street 2:BLDG 49-201
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1330
Mailing Address - Country:US
Mailing Address - Phone:954-389-4624
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-324-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist