Provider Demographics
NPI:1336422849
Name:KAUTZ, DONALD L (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:L
Last Name:KAUTZ
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 1:2602 S TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2401
Mailing Address - Country:US
Mailing Address - Phone:970-267-5110
Mailing Address - Fax:970-267-5111
Practice Address - Street 1:2602 S TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2401
Practice Address - Country:US
Practice Address - Phone:970-267-5110
Practice Address - Fax:970-267-5111
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist