Healthcare Provider Details

I. General information

NPI: 1023311891
Provider Name (Legal Business Name): ANTHONIA KUTI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 ELMWOOD AVE
PROVIDENCE RI
02907-1758
US

IV. Provider business mailing address

533 ELMWOOD AVE
PROVIDENCE RI
02907-1758
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-7930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04835
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: