Provider Demographics
NPI:1720352750
Name:SCHUTTPELZ, KIMBERLEE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:LYNN
Last Name:SCHUTTPELZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 W EVANS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-4613
Mailing Address - Country:US
Mailing Address - Phone:541-476-4262
Mailing Address - Fax:541-474-1443
Practice Address - Street 1:414 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2810
Practice Address - Country:US
Practice Address - Phone:541-476-4262
Practice Address - Fax:541-474-1443
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORORRPH91071835P0018X
OR9107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR9107OtherRPH LICENSE NUMBER