Healthcare Provider Details

I. General information

NPI: 1558632455
Provider Name (Legal Business Name): MICHAEL K PUTZE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 PASADENA AVE S
SOUTH PASADENA FL
33707-3717
US

IV. Provider business mailing address

1501 PASADENA AVE S
SOUTH PASADENA FL
33707-3717
US

V. Phone/Fax

Practice location:
  • Phone: 412-716-3457
  • Fax:
Mailing address:
  • Phone: 412-716-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 38330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: