MEDICARE: DR. MISTY M STUTZ PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	011257	KY
2	183500000X	Pharmacist	03-1-17413	OH

General Provider Information

NPI Number	:	1205905643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MISTY M STUTZ PHARMD

Provider Business Mailing Address
First Line	:	7504 KAVANAUGH RD
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9446
Country	:	US
Telephone Number	:	502-243-1437
Fax Number	:	502-243-9053

Provider Business Practice Location Address
First Line	:	6425 W HIGHWAY 146
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9575
Country	:	US
Telephone Number	:	502-243-4094
Fax Number	:	502-243-9053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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