Healthcare Provider Details

I. General information

NPI: 1215300223
Provider Name (Legal Business Name): LUCY KUTSCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 MARION MOUNT GILEAD RD
MARION OH
43302-8990
US

IV. Provider business mailing address

184 E COUNTY ROAD 16
TIFFIN OH
44883-8932
US

V. Phone/Fax

Practice location:
  • Phone: 740-389-0510
  • Fax: 740-389-0565
Mailing address:
  • Phone: 491-448-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03120931
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: