Provider Demographics
NPI:1285813063
Name:SCHAEFER, CARMEN MARIA (RPH)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:MARIA
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:CARMEN
Other - Middle Name:MARIA
Other - Last Name:LOIBL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:238 HOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3326
Mailing Address - Country:US
Mailing Address - Phone:845-486-6166
Mailing Address - Fax:
Practice Address - Street 1:238 HOOKER AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3326
Practice Address - Country:US
Practice Address - Phone:845-486-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00882040Medicaid