Provider Demographics
NPI:1487786711
Name:MARUTZ, LYNN JOEL (RPH)
Entity type:Individual
Prefix:MR
First Name:LYNN
Middle Name:JOEL
Last Name:MARUTZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4746 HAVANA AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-5026
Mailing Address - Country:US
Mailing Address - Phone:616-531-2576
Mailing Address - Fax:
Practice Address - Street 1:1029 4 MILE RD NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1504
Practice Address - Country:US
Practice Address - Phone:616-784-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist