Healthcare Provider Details

I. General information

NPI: 1366145674
Provider Name (Legal Business Name): KARLY KUTSCHBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SYCAMORE LINE
SANDUSKY OH
44870-4128
US

IV. Provider business mailing address

912 SYCAMORE LINE APT 1B
SANDUSKY OH
44870-4050
US

V. Phone/Fax

Practice location:
  • Phone: 419-625-2258
  • Fax:
Mailing address:
  • Phone: 419-921-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: