Provider Demographics
NPI:1598967952
Name:LUTGEN, PHILIP LEWIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:LEWIS
Last Name:LUTGEN
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 1:1322 JENSEN CT
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018
Mailing Address - Country:US
Mailing Address - Phone:262-646-2311
Mailing Address - Fax:
Practice Address - Street 1:1300 PABST FARMS CIR
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4854
Practice Address - Country:US
Practice Address - Phone:262-200-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist