Provider Demographics
NPI:1063052652
Name:KLUTTZ, DEBORAH BROSNAN (PHARMACIST RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:BROSNAN
Last Name:KLUTTZ
Suffix:
Gender:F
Credentials:PHARMACIST RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 SILAS MOFFITT WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8831
Mailing Address - Country:US
Mailing Address - Phone:317-946-3617
Mailing Address - Fax:
Practice Address - Street 1:200 NEW ALBANY PLZ
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4658
Practice Address - Country:US
Practice Address - Phone:812-948-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020677A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist