Healthcare Provider Details

I. General information

NPI: 1275086910
Provider Name (Legal Business Name): LEAH EVE KUTZY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 BROAD ST
BRIDGEWATER MA
02324-1741
US

IV. Provider business mailing address

233 BROAD ST
BRIDGEWATER MA
02324-1741
US

V. Phone/Fax

Practice location:
  • Phone: 508-697-2564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234191
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: