Healthcare Provider Details

I. General information

NPI: 1578743035
Provider Name (Legal Business Name): CAROLYN A SCHUTRUM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CHEMUNG ST
HORSEHEADS NY
14845-2711
US

IV. Provider business mailing address

507 CHEMUNG ST
HORSEHEADS NY
14845-2711
US

V. Phone/Fax

Practice location:
  • Phone: 607-739-0301
  • Fax: 607-739-0072
Mailing address:
  • Phone: 607-739-0301
  • Fax: 607-739-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number039521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: