Provider Demographics
NPI:1215212733
Name:WILLETT, AMBER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:WILLETT
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 1:817 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1240
Mailing Address - Country:US
Mailing Address - Phone:270-527-9374
Mailing Address - Fax:270-527-3152
Practice Address - Street 1:817 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1240
Practice Address - Country:US
Practice Address - Phone:270-527-9374
Practice Address - Fax:270-527-3152
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist