1336665066 NPI number — JAMIE KATHERINE SCHRAER PHARMD.

Table of content: JAMIE KATHERINE SCHRAER PHARMD. (NPI 1336665066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336665066 NPI number — JAMIE KATHERINE SCHRAER PHARMD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHRAER
Provider First Name:
JAMIE
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUESENBERRY
Provider Other First Name:
JAMIE
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336665066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 337
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARBRO
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25917-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-469-3424
Provider Business Mailing Address Fax Number:
304-465-2266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 SCARBRO ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCARBRO
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-469-3424
Provider Business Practice Location Address Fax Number:
304-465-2266
Provider Enumeration Date:
08/15/2017

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: 1835P2201X , with the licence number:  RP0008552 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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