Provider Demographics
NPI:1174862510
Name:KUTOK, MARCY A (BSPHARM, PHARMD)
Entity Type:Individual
Prefix:MS
First Name:MARCY
Middle Name:A
Last Name:KUTOK
Suffix:
Gender:F
Credentials:BSPHARM, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE # 359912
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2499
Mailing Address - Country:US
Mailing Address - Phone:206-744-5672
Mailing Address - Fax:206-744-5005
Practice Address - Street 1:325 9TH AVE # 359912
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2499
Practice Address - Country:US
Practice Address - Phone:206-744-5672
Practice Address - Fax:206-744-5005
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59371183500000X
WAPH00015068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist