Provider Demographics
NPI:1396020822
Name:TUTTLE, REX LEE (RPH)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:LEE
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5165 W 60TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-7062
Mailing Address - Country:US
Mailing Address - Phone:563-388-9128
Mailing Address - Fax:
Practice Address - Street 1:1660 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-3636
Practice Address - Country:US
Practice Address - Phone:563-324-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14501183500000X
IL051029272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist