Provider Demographics
NPI:1982207106
Name:LUTZ, MICHELE ANN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7226
Mailing Address - Country:US
Mailing Address - Phone:757-259-7892
Mailing Address - Fax:757-259-7897
Practice Address - Street 1:7529 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7226
Practice Address - Country:US
Practice Address - Phone:757-259-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist