Provider Demographics
NPI:1003020140
Name:PUETZ, KATE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:
Last Name:PUETZ
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 1:8515 DOUGLAS AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2924
Mailing Address - Country:US
Mailing Address - Phone:515-270-0713
Mailing Address - Fax:515-270-2979
Practice Address - Street 1:8515 DOUGLAS AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-2924
Practice Address - Country:US
Practice Address - Phone:515-270-0713
Practice Address - Fax:515-270-2979
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20107183500000X
WI14400-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist