Healthcare Provider Details

I. General information

NPI: 1174259378
Provider Name (Legal Business Name): DOLORES ANNE KUTZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S CROATAN HWY
KILL DEVIL HILLS NC
27948-8708
US

IV. Provider business mailing address

102 DUCHESS CT
KILL DEVIL HILLS NC
27948-9125
US

V. Phone/Fax

Practice location:
  • Phone: 252-441-3633
  • Fax:
Mailing address:
  • Phone: 824-440-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19381
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: