Provider Demographics
NPI:1063012490
Name:REMMERT, DEANNE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:MARIE
Last Name:REMMERT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8703 SURGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-5031
Mailing Address - Country:US
Mailing Address - Phone:618-219-0970
Mailing Address - Fax:
Practice Address - Street 1:12495 STATE ROUTE 143
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1295
Practice Address - Country:US
Practice Address - Phone:618-654-2397
Practice Address - Fax:618-654-2399
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist