Provider Demographics
NPI:1023491958
Name:LUITJENS, JOEL (RPH)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:LUITJENS
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 1:599 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1927
Mailing Address - Country:US
Mailing Address - Phone:507-831-4161
Mailing Address - Fax:507-831-4289
Practice Address - Street 1:599 2ND AVE N
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1927
Practice Address - Country:US
Practice Address - Phone:507-831-4161
Practice Address - Fax:507-831-4289
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114383OtherSTATE LICENSE