Provider Demographics
NPI:1376989269
Name:REITHMEYER, AMY BETH
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:REITHMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 JANESVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2705
Mailing Address - Country:US
Mailing Address - Phone:920-563-9351
Mailing Address - Fax:920-563-7996
Practice Address - Street 1:1425 JANESVILLE AVE
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2705
Practice Address - Country:US
Practice Address - Phone:920-563-9351
Practice Address - Fax:920-563-7996
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11093-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist