Provider Demographics
NPI:1558815746
Name:NUTT, CHARLOTTE AMANDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:AMANDA
Last Name:NUTT
Suffix:
Gender:F
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:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:CO
Mailing Address - Zip Code:81639-1595
Mailing Address - Country:US
Mailing Address - Phone:970-761-3855
Mailing Address - Fax:
Practice Address - Street 1:1825 CENTRAL PARK PLZ
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80477-5416
Practice Address - Country:US
Practice Address - Phone:307-635-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3926183500000X
COPHA.0021367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist