Provider Demographics
NPI:1831240332
Name:KAMTZ, GARY LEE (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:KAMTZ
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 1:6753 R RD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NE
Mailing Address - Zip Code:68421-8708
Mailing Address - Country:US
Mailing Address - Phone:402-242-2049
Mailing Address - Fax:
Practice Address - Street 1:2220 J ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-2602
Practice Address - Country:US
Practice Address - Phone:402-274-4186
Practice Address - Fax:402-242-4222
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist