Provider Demographics
NPI:1265443899
Name:DUTCHER ENTERPRISES
Entity Type:Organization
Organization Name:DUTCHER ENTERPRISES
Other - Org Name:REMEDIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:928-536-2044
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-0919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 E WHITE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935-7171
Practice Address - Country:US
Practice Address - Phone:928-367-3868
Practice Address - Fax:928-367-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ44633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0354314OtherOTHER ID NUMBER-COMMERCIAL NUMBER