Provider Demographics
NPI:1235412297
Name:UTZ, LEONARD JOHN
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:JOHN
Last Name:UTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12343 MERIBEAU CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1443
Mailing Address - Country:US
Mailing Address - Phone:316-616-8750
Mailing Address - Fax:
Practice Address - Street 1:2229 N MAIZE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-7301
Practice Address - Country:US
Practice Address - Phone:316-722-0741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-09994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist