Provider Demographics
NPI:1053093146
Name:NORTZ, KATELYN JO
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:JO
Last Name:NORTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6268 COUNTY ROUTE 17
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13437-2709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 STATE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1419
Practice Address - Country:US
Practice Address - Phone:315-493-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist