Provider Demographics
NPI:1699126920
Name:PUTZ, COURTNEY MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:PUTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 BOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-2490
Mailing Address - Country:US
Mailing Address - Phone:920-948-7743
Mailing Address - Fax:
Practice Address - Street 1:248 E HILL PKWY
Practice Address - Street 2:APT 109
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-3310
Practice Address - Country:US
Practice Address - Phone:920-948-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18385-401835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist