Provider Demographics
NPI:1174615637
Name:WITTE, AMY POORE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:POORE
Last Name:WITTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78113
Mailing Address - Country:US
Mailing Address - Phone:830-254-3245
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF THE INCARNATE WORD
Practice Address - Street 2:4301 BROADWAY, CPO #99
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-883-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX426211835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX42621OtherPHARMACY LICENSE