Provider Demographics
NPI:1265054134
Name:LUTZ, RANDOLPH W (RPH)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:W
Last Name:LUTZ
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 1:11300 CORPORATE AVE
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1374
Mailing Address - Country:US
Mailing Address - Phone:913-588-2370
Mailing Address - Fax:913-574-0252
Practice Address - Street 1:11300 CORPORATE AVE
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1374
Practice Address - Country:US
Practice Address - Phone:913-449-4992
Practice Address - Fax:913-574-0252
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist