Provider Demographics
NPI:1851919328
Name:STULTZ, TROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:
Last Name:STULTZ
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 1:640 STATE ROUTE 20 UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284
Mailing Address - Country:US
Mailing Address - Phone:360-503-1676
Mailing Address - Fax:360-503-1677
Practice Address - Street 1:640 STATE ROUTE 20 UNIT A
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-503-1676
Practice Address - Fax:360-503-1677
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist