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NPI Code Detail

MEDICARE: STEVEN LUTZ JR.

MEDICARE: STEVEN LUTZ JR.
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
1183500000XPharmacist0202213303VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10202213303OTHERVAPHARMACIST LICENSE

General Provider Information

NPI Number : 1629517651
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN LUTZ JR.
Provider Business Mailing Address
First Line : 4245 HOLLAND RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-1904
Country : US
Telephone Number : 757-474-2289
Fax Number :
Provider Business Practice Location Address
First Line : 4245 HOLLAND RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-1904
Country : US
Telephone Number : 757-474-2289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2017
Last Update Date : 02/23/2017

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