Healthcare Provider Details

I. General information

NPI: 1720190739
Provider Name (Legal Business Name): UTTER ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 PENNSYLVANIA AVE
ELMIRA NY
14904-2239
US

IV. Provider business mailing address

627 PENNSYLVANIA AVE
ELMIRA NY
14904-2239
US

V. Phone/Fax

Practice location:
  • Phone: 607-732-8829
  • Fax: 607-732-0550
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number023722
License Number StateNY

VIII. Authorized Official

Name: SUSAN GUINN
Title or Position: BILLING SPEC
Credential:
Phone: 314-993-6000