Healthcare Provider Details

I. General information

NPI: 1679627533
Provider Name (Legal Business Name): DUTCHER ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 HIGHWAY 260 #4
OVERGAARD AZ
85933-2019
US

IV. Provider business mailing address

2841 HIGHWAY 260 #4 P.O. BOX 2019
OVERGAARD AZ
85933-2019
US

V. Phone/Fax

Practice location:
  • Phone: 928-535-6626
  • Fax: 928-535-6628
Mailing address:
  • Phone: 928-535-6626
  • Fax: 928-535-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2984
License Number StateAZ

VIII. Authorized Official

Name: MR. CHARLES ALLEN DUTCHER
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 928-536-2044