Provider Demographics
NPI:1093997462
Name:SUTTER, JOHN GERARD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GERARD
Last Name:SUTTER
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 1:700 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HORICON
Mailing Address - State:WI
Mailing Address - Zip Code:53032-1655
Mailing Address - Country:US
Mailing Address - Phone:920-485-3400
Mailing Address - Fax:920-485-3409
Practice Address - Street 1:700 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HORICON
Practice Address - State:WI
Practice Address - Zip Code:53032-1655
Practice Address - Country:US
Practice Address - Phone:920-485-3400
Practice Address - Fax:920-485-3409
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist