Provider Demographics
NPI:1528060274
Name:SCHAEFER, PETER M (RPH)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:M
Last Name:SCHAEFER
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 1:99 CASSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3055
Mailing Address - Country:US
Mailing Address - Phone:770-387-9174
Mailing Address - Fax:
Practice Address - Street 1:824 WEST AVE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-6100
Practice Address - Country:US
Practice Address - Phone:770-606-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARPH19518183500000X
GARPH015584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist