Provider Demographics
NPI:1609962364
Name:KUYPER, ANTHONY (RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:KUYPER
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:HC 70 BOX 12
Mailing Address - Street 2:
Mailing Address - City:TONALEA
Mailing Address - State:AZ
Mailing Address - Zip Code:86044-9611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:INSCRIPTION HOUSE HEALTH CENTER
Practice Address - Street 2:1 MI. N. ON NAVAJO RT 16
Practice Address - City:SHONTO
Practice Address - State:AZ
Practice Address - Zip Code:86054-7397
Practice Address - Country:US
Practice Address - Phone:928-672-3029
Practice Address - Fax:928-672-3005
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist