Provider Demographics
NPI:1639310683
Name:STUTZ, JON (BSP)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:STUTZ
Suffix:
Gender:M
Credentials:BSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GREENLEY RD
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5200
Mailing Address - Country:US
Mailing Address - Phone:209-536-3690
Mailing Address - Fax:
Practice Address - Street 1:1000 GREENLEY RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5200
Practice Address - Country:US
Practice Address - Phone:209-536-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353001801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist