Healthcare Provider Details

I. General information

NPI: 1417687237
Provider Name (Legal Business Name): JULIE IRENE KUTZ CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE IRENE CORDRAY CPHT

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N LAFAYETTE ST
GREENVILLE MI
48838-1166
US

IV. Provider business mailing address

209 S SHERMAN ST
SHERIDAN MI
48884-9642
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-3625
  • Fax: 616-754-2726
Mailing address:
  • Phone: 616-255-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303015079
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: