Healthcare Provider Details

I. General information

NPI: 1265443899
Provider Name (Legal Business Name): DUTCHER ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E WHITE MOUNTAIN BLVD
PINETOP AZ
85935-7171
US

IV. Provider business mailing address

PO BOX 919
TAYLOR AZ
85939-0919
US

V. Phone/Fax

Practice location:
  • Phone: 928-367-3868
  • Fax: 928-367-3966
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAZ4463
License Number StateAZ

VIII. Authorized Official

Name: CHARLES DUTCHER
Title or Position: OWNER
Credential: RPH
Phone: 928-536-2044