Provider Demographics
NPI:1538476056
Name:STOUT, TY CURTIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:CURTIS
Last Name:STOUT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1587
Mailing Address - Country:US
Mailing Address - Phone:661-399-2901
Mailing Address - Fax:661-399-2908
Practice Address - Street 1:2819 N. CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308
Practice Address - Country:US
Practice Address - Phone:661-399-2901
Practice Address - Fax:661-399-2908
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist