Provider Demographics
NPI:1417304882
Name:KUTA, LAUREN MELINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MELINA
Last Name:KUTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:MELINA
Other - Last Name:LINDGREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8730 W DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5108
Mailing Address - Country:US
Mailing Address - Phone:847-296-3678
Mailing Address - Fax:
Practice Address - Street 1:8730 W DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5108
Practice Address - Country:US
Practice Address - Phone:847-296-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist