Healthcare Provider Details

I. General information

NPI: 1205057270
Provider Name (Legal Business Name): GREGORY SCHUTRUM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MOUNT ZOAR ST
ELMIRA NY
14904-1231
US

IV. Provider business mailing address

1400 COUNTY ROUTE 64
HORSEHEADS NY
14845-2297
US

V. Phone/Fax

Practice location:
  • Phone: 607-733-5636
  • Fax:
Mailing address:
  • Phone: 607-739-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number039592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: