Healthcare Provider Details

I. General information

NPI: 1699075275
Provider Name (Legal Business Name): STEVE H KUTTENKULER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W JEFFERSON ST
KIRKSVILLE MO
63501-1443
US

IV. Provider business mailing address

800 W JEFFERSON ST
KIRKSVILLE MO
63501-1443
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-7239
  • Fax: 660-665-6474
Mailing address:
  • Phone: 660-665-7239
  • Fax: 660-665-6474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044205
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: