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General NPI Number Information
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NPI Number | 1205905643
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Entity Type | Individual
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Provider Name | MISTY M STUTZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6425 W HIGHWAY 146
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City | CRESTWOOD
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State | KY
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Zip | 40014-9575
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Country | US
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Telephone | 502-243-4094
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Fax | 502-243-9053
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Provider Business Mailing Address
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Address Line | 7504 KAVANAUGH RD
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City | CRESTWOOD
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State | KY
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Zip | 40014-9446
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Country | US
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Telephone | 502-243-1437
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Fax | 502-243-9053
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 011257
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03-1-17413
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License Number State | OH
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