Provider Demographics
NPI:1366145674
Name:KUTSCHBACH, KARLY
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:KUTSCHBACH
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 1:912 SYCAMORE LINE APT 1B
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4050
Mailing Address - Country:US
Mailing Address - Phone:419-921-2282
Mailing Address - Fax:
Practice Address - Street 1:1420 SYCAMORE LINE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4128
Practice Address - Country:US
Practice Address - Phone:419-625-2258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician