Healthcare Provider Details

I. General information

NPI: 1205055316
Provider Name (Legal Business Name): JOHN DAVID KUTHE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 SILVER HEIGHTS BLVD
SILVER CITY NM
88061
US

IV. Provider business mailing address

1308 SILVER HEIGHTS BLVD
SILVER CITY NM
88061
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1579
  • Fax: 575-538-0525
Mailing address:
  • Phone: 575-388-1579
  • Fax: 575-538-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5675
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26055
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00003912
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP00003912
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number26055
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number5675
License Number StateAZ
# 7
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS005675
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: