Provider Demographics
NPI:1730845439
Name:SCHULTZ, MERRITT MILLER
Entity type:Individual
Prefix:
First Name:MERRITT
Middle Name:MILLER
Last Name:SCHULTZ
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 1:15150 BLANCO RD APT 9205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3332
Mailing Address - Country:US
Mailing Address - Phone:814-243-3922
Mailing Address - Fax:
Practice Address - Street 1:SPC TAYLOR BURKE CLINIC
Practice Address - Street 2:BLDG 5026 CAMP BULLIS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:210-295-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist