MEDICARE: MR. DONALD L KAUTZ R.PH

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
1	183500000X	Pharmacist	11114	CO

General Provider Information

NPI Number	:	1336422849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD L KAUTZ R.PH

Provider Business Mailing Address
First Line	:	2602 S TIMBERLINE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2401
Country	:	US
Telephone Number	:	970-267-5110
Fax Number	:	970-267-5111

Provider Business Practice Location Address
First Line	:	2602 S TIMBERLINE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2401
Country	:	US
Telephone Number	:	970-267-5110
Fax Number	:	970-267-5111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	05/24/2013

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