Healthcare Provider Details

I. General information

NPI: 1831371392
Provider Name (Legal Business Name): STUART KUTCHER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 JACKSON AVE
SYOSSET NY
11791-3609
US

IV. Provider business mailing address

103 JACKSON AVE
SYOSSET NY
11791
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-2811
  • Fax: 516-921-4484
Mailing address:
  • Phone: 516-921-2811
  • Fax: 516-921-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number030216
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: