Provider Demographics
NPI:1033285986
Name:GUTAY, IMRE LASZLO (RPH)
Entity Type:Individual
Prefix:MR
First Name:IMRE
Middle Name:LASZLO
Last Name:GUTAY
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 1:4507 PACES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712
Mailing Address - Country:US
Mailing Address - Phone:573-268-0018
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:PHARMACY SERVICE (119)
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-286-6987
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017258A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist