1538773957 NPI number — DR. MICHELLE LEIGH SCHRAMM PHARMD

Table of content: DR. MICHELLE LEIGH SCHRAMM PHARMD (NPI 1538773957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538773957 NPI number — DR. MICHELLE LEIGH SCHRAMM PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHRAMM
Provider First Name:
MICHELLE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
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:
PEARLMAN
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538773957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 CLAUDE BAILEY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61356-8618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-875-4551
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 CLAUDE BAILEY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61356-8618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-875-4551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2020

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: 183500000X , with the licence number:  051.290764 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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