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NPI Code Detail

MEDICARE: KRISTIN KEUTZER

MEDICARE: KRISTIN KEUTZER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist2005002696MO

General Provider Information

NPI Number : 1134404825
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN KEUTZER
Provider Business Mailing Address
First Line : 600 W KARSCH BLVD
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-3342
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 W KARSCH BLVD
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-3342
Country : US
Telephone Number : 573-747-1591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2011
Last Update Date : 10/13/2011

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1407132525 — KRISTIE HALTER
Practice Location Address:
600 W KARSCH BLVD
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63640-3342
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Practice Fax: 573-747-0761

Directions to “ KRISTIN KEUTZER ” Practice Location

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