Provider Demographics
NPI:1679627533
Name:DUTCHER ENTERPRISES
Entity type:Organization
Organization Name:DUTCHER ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:928-536-2044
Mailing Address - Street 1:2841 HIGHWAY 260 #4
Mailing Address - Street 2:P.O. BOX 2019
Mailing Address - City:OVERGAARD
Mailing Address - State:AZ
Mailing Address - Zip Code:85933-2019
Mailing Address - Country:US
Mailing Address - Phone:928-535-6626
Mailing Address - Fax:928-535-6628
Practice Address - Street 1:2841 HIGHWAY 260 #4
Practice Address - Street 2:
Practice Address - City:OVERGAARD
Practice Address - State:AZ
Practice Address - Zip Code:85933-2019
Practice Address - Country:US
Practice Address - Phone:928-535-6626
Practice Address - Fax:928-535-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2984333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2984OtherPHARMACY LICENSE
AZ438988OtherAHCCCS NUMBER
AZ438988OtherAHCCCS NUMBER