Provider Demographics
NPI:1609612720
Name:SCHUESSLER, CARLIE REBECCA
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:REBECCA
Last Name:SCHUESSLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 COLLINSVILLE CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-1880
Mailing Address - Country:US
Mailing Address - Phone:618-343-0297
Mailing Address - Fax:
Practice Address - Street 1:1190 COLLINSVILLE CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-1880
Practice Address - Country:US
Practice Address - Phone:618-343-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.312216183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician