Provider Demographics
NPI:1588098107
Name:SCHNAIDT, AMY MISUN
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MISUN
Last Name:SCHNAIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MISUN
Other - Last Name:YON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2440 DANIELS ST
Mailing Address - Street 2:COSTCO PHARMACY DEPARTMENT
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-6745
Mailing Address - Country:US
Mailing Address - Phone:209-825-8209
Mailing Address - Fax:209-825-8206
Practice Address - Street 1:3881 E COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-4017
Practice Address - Country:US
Practice Address - Phone:916-265-9604
Practice Address - Fax:916-265-9595
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist