Active NPI
Kellie Marie Lutgen, PHARMD
- Pharmacist
- Kernersville, NC
National Provider Identifier
1629410931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 23415
- Practice address
- 1398 Union Cross Rd
Kernersville, NC 27284-7532 - Phone
- (336) 993-9600
- NPI assigned
- Jul 27, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 23415 | NC | Primary |
Addresses
Primary practice location
1398 Union Cross Rd
Kernersville, NC 27284-7532
Mailing address
5307 Broadwater Dr
Kernersville, NC 27284-3867
Phone (336) 830-1506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23415 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374883200000",
"number": "1629410931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5307 BROADWATER DR",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272843867",
"telephone_number": "336-830-1506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1398 UNION CROSS RD",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272847532",
"telephone_number": "336-993-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTGEN",
"first_name": "KELLIE",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-27",
"last_updated": "2013-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "23415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.