Healthcare Provider Details

I. General information

NPI: 1356461057
Provider Name (Legal Business Name): PETER LUTZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 GREEN ST
GARDNER MA
01440-1373
US

IV. Provider business mailing address

64 BEAVERBROOK RD
BURLINGTON MA
01803-1228
US

V. Phone/Fax

Practice location:
  • Phone: 978-630-6358
  • Fax: 978-630-5096
Mailing address:
  • Phone: 617-872-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20488
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: