Provider Demographics
NPI:1417687237
Name:KUTZ, JULIE IRENE (CPHT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:IRENE
Last Name:KUTZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:IRENE
Other - Last Name:CORDRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:209 S SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-9642
Mailing Address - Country:US
Mailing Address - Phone:616-255-3194
Mailing Address - Fax:
Practice Address - Street 1:507 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1166
Practice Address - Country:US
Practice Address - Phone:616-754-3625
Practice Address - Fax:616-754-2726
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303015079183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician