1265484778 NPI number — DR. KIMBERLY ROXANNE SCHNACKY PHARMD, BCPS

Table of content: DR. KIMBERLY ROXANNE SCHNACKY PHARMD, BCPS (NPI 1265484778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265484778 NPI number — DR. KIMBERLY ROXANNE SCHNACKY PHARMD, BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNACKY
Provider First Name:
KIMBERLY
Provider Middle Name:
ROXANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, BCPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265484778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7015 BRAMLEA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDERMERE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34786-6624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-905-9756
Provider Business Mailing Address Fax Number:
321-397-6113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 RAYMOND ST
Provider Second Line Business Practice Location Address:
ORLANDO VA HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-599-1378
Provider Business Practice Location Address Fax Number:
321-397-6113
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  PS 0033071 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1835P0018X , with the licence number: PS0033071 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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