Provider Demographics
NPI:1215149984
Name:SCHULTZ, MITCHELL C (RPH)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:C
Last Name:SCHULTZ
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:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-0029
Mailing Address - Country:US
Mailing Address - Phone:701-567-2220
Mailing Address - Fax:
Practice Address - Street 1:105 6TH ST SE
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639
Practice Address - Country:US
Practice Address - Phone:701-567-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist