Provider Demographics
NPI:1629354238
Name:LUTZ, ALICIA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:M
Last Name:LUTZ
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 1:21010 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4305
Mailing Address - Country:US
Mailing Address - Phone:440-333-8205
Mailing Address - Fax:440-333-8227
Practice Address - Street 1:21010 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-4305
Practice Address - Country:US
Practice Address - Phone:440-333-8205
Practice Address - Fax:440-333-8227
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-28320183500000X
PARP442072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist