Provider Demographics
NPI:1396185476
Name:LOERTSCHER, GEORGE DELOY (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DELOY
Last Name:LOERTSCHER
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 1:1631 S 75 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5218
Mailing Address - Country:US
Mailing Address - Phone:801-499-2402
Mailing Address - Fax:
Practice Address - Street 1:1631 S 75 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5218
Practice Address - Country:US
Practice Address - Phone:801-499-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT127856-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist