Provider Demographics
NPI:1992089171
Name:SCHNEIDER, THOMAS J
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:SCHNEIDER
Suffix:
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 1:9702 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-2755
Mailing Address - Country:US
Mailing Address - Phone:618-566-9562
Mailing Address - Fax:
Practice Address - Street 1:5890 N BELT W
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-4618
Practice Address - Country:US
Practice Address - Phone:618-277-4440
Practice Address - Fax:618-277-5857
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-040448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist