Provider Demographics
NPI:1851648844
Name:LUTSY, JUSTIN LUTSY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LUTSY
Last Name:LUTSY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 71ST ST SE APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:69 LEWIS ST
Practice Address - Street 2:ROUTE 3 BOX 67
Practice Address - City:WHITESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25209
Practice Address - Country:US
Practice Address - Phone:304-854-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist