Healthcare Provider Details

I. General information

NPI: 1235412297
Provider Name (Legal Business Name): LEONARD JOHN UTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 N MAIZE RD
WICHITA KS
67205-7301
US

IV. Provider business mailing address

12343 MERIBEAU CT
WICHITA KS
67235-1443
US

V. Phone/Fax

Practice location:
  • Phone: 316-722-0741
  • Fax:
Mailing address:
  • Phone: 316-616-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2-09994
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: