Provider Demographics
NPI:1205055316
Name:KUTHE, JOHN DAVID (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:KUTHE
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 1:1308 SILVER HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-388-1579
Mailing Address - Fax:575-538-0525
Practice Address - Street 1:1308 SILVER HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-388-1579
Practice Address - Fax:575-538-0525
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5675183500000X, 1835G0303X
TX26055183500000X, 1835G0303X
NMRP00003912183500000X, 1835G0303X
AZS005675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric