Provider Demographics
NPI:1114450178
Name:CUTLER, MICHELE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CUTLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 WASHINGTON ST S
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5530
Mailing Address - Country:US
Mailing Address - Phone:208-736-7060
Mailing Address - Fax:208-735-2865
Practice Address - Street 1:995 WASHINGTON ST S
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5530
Practice Address - Country:US
Practice Address - Phone:208-736-7060
Practice Address - Fax:208-735-2865
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist