Provider Demographics
NPI:1083434880
Name:GUTOSKI, RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:GUTOSKI
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 1:21044 N JOHN WAYNE PKWY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2916
Mailing Address - Country:US
Mailing Address - Phone:520-836-4401
Mailing Address - Fax:520-836-4403
Practice Address - Street 1:21044 N JOHN WAYNE PKWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2916
Practice Address - Country:US
Practice Address - Phone:520-836-4401
Practice Address - Fax:520-836-4403
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist