Healthcare Provider Details

I. General information

NPI: 1508042573
Provider Name (Legal Business Name): MRS. ANNETTE LUTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 W STATE ROUTE 41
COVINGTON OH
45318-1248
US

IV. Provider business mailing address

8264 W STATE ROUTE 41
COVINGTON OH
45318-1248
US

V. Phone/Fax

Practice location:
  • Phone: 800-232-4239
  • Fax:
Mailing address:
  • Phone: 800-232-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03320248
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26016000A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: