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General NPI Number Information
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NPI Number | 1063808673
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Entity Type | Individual
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Provider Name | CAILIN LUTZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 4105 E AMY LN
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-8178
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Country | US
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Telephone | 803-319-4863
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 E AMY LN
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-8178
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Country | US
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Telephone | 803-319-4863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 11223
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RPH022200
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License Number State | GA
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