Healthcare Provider Details

I. General information

NPI: 1609962364
Provider Name (Legal Business Name): ANTHONY KUYPER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INSCRIPTION HOUSE HEALTH CENTER 1 MI. N. ON NAVAJO RT 16
SHONTO AZ
86054-7397
US

IV. Provider business mailing address

HC 70 BOX 12
TONALEA AZ
86044-9611
US

V. Phone/Fax

Practice location:
  • Phone: 928-672-3029
  • Fax: 928-672-3005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16149
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: