Provider Demographics
NPI:1578743035
Name:SCHUTRUM, CAROLYN A (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:SCHUTRUM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 CHEMUNG ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2711
Mailing Address - Country:US
Mailing Address - Phone:607-739-0301
Mailing Address - Fax:607-739-0072
Practice Address - Street 1:507 CHEMUNG ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2711
Practice Address - Country:US
Practice Address - Phone:607-739-0301
Practice Address - Fax:607-739-0072
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00352098Medicaid