Provider Demographics
NPI:1750405478
Name:LUTZ, FREDERICK WILLIS
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:WILLIS
Last Name:LUTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-9426
Mailing Address - Country:US
Mailing Address - Phone:607-749-7533
Mailing Address - Fax:
Practice Address - Street 1:7 HOLLEY DR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-9426
Practice Address - Country:US
Practice Address - Phone:607-749-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist