Provider Demographics
NPI:1548355324
Name:SCHIMMEL, MICHAEL LEWIS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEWIS
Last Name:SCHIMMEL
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 1:19128 HARBORBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9717
Mailing Address - Country:US
Mailing Address - Phone:813-909-8380
Mailing Address - Fax:
Practice Address - Street 1:18407 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4470
Practice Address - Country:US
Practice Address - Phone:813-948-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0036118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0556050047Medicare ID - Type Unspecified
FL0556050047Medicare ID - Type Unspecified