Provider Demographics
NPI:1699257840
Name:SCHELLENBAUM, MARK II
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SCHELLENBAUM
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19003 N R H JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4402
Mailing Address - Country:US
Mailing Address - Phone:623-584-3002
Mailing Address - Fax:
Practice Address - Street 1:19003 N R H JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4402
Practice Address - Country:US
Practice Address - Phone:623-584-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist