Provider Demographics
NPI:1053653055
Name:FOUTZ, DEWEY K III (PHARMD, PHC)
Entity Type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:K
Last Name:FOUTZ
Suffix:III
Gender:M
Credentials:PHARMD, PHC
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:FOUTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-960-7801
Mailing Address - Fax:
Practice Address - Street 1:6 ROAD 7586
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-4934
Practice Address - Country:US
Practice Address - Phone:505-960-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC000002581835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist