Healthcare Provider Details

I. General information

NPI: 1326903626
Provider Name (Legal Business Name): JOHN JOSEPH TUTEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S MAIN ST
DEFOREST WI
53532-1421
US

IV. Provider business mailing address

645 S MAIN ST
DEFOREST WI
53532-1421
US

V. Phone/Fax

Practice location:
  • Phone: 608-846-4736
  • Fax: 608-846-6892
Mailing address:
  • Phone: 608-846-4736
  • Fax: 608-846-6892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11738-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: