Provider Demographics
NPI:1811469091
Name:KUTZ, ALEXIS RAE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RAE
Last Name:KUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 BROOKLAWN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2875
Mailing Address - Country:US
Mailing Address - Phone:865-671-7920
Mailing Address - Fax:
Practice Address - Street 1:5201 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2345
Practice Address - Country:US
Practice Address - Phone:865-686-1020
Practice Address - Fax:865-686-1021
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN441851835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist