Provider Demographics
NPI:1942334412
Name:PUETZ, ROBROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBROY
Middle Name:
Last Name:PUETZ
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 1:64 EAST ST
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NY
Mailing Address - Zip Code:11901-4204
Mailing Address - Country:US
Mailing Address - Phone:631-668-2994
Mailing Address - Fax:631-668-1109
Practice Address - Street 1:95 ON THE PLAZA
Practice Address - Street 2:
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954-7407
Practice Address - Country:US
Practice Address - Phone:203-507-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV155271835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric