Provider Demographics
NPI:1104356021
Name:KUTZ, JENNIFER (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KUTZ
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KUTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:1401 33RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3413
Mailing Address - Country:US
Mailing Address - Phone:701-235-5511
Mailing Address - Fax:
Practice Address - Street 1:1401 33RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3413
Practice Address - Country:US
Practice Address - Phone:701-235-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist