Provider Demographics
NPI:1700619905
Name:KLUTTZ SHELTON, OLIVIA JUNE (CPHT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JUNE
Last Name:KLUTTZ SHELTON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 SHOCCO SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-8728
Mailing Address - Country:US
Mailing Address - Phone:919-514-7559
Mailing Address - Fax:
Practice Address - Street 1:309 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509
Practice Address - Country:US
Practice Address - Phone:919-575-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66845183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician