Provider Demographics
NPI:1437464534
Name:AERTKER, AMIE (RPH)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:AERTKER
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 1:70997 HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3249
Mailing Address - Country:US
Mailing Address - Phone:985-892-1550
Mailing Address - Fax:985-892-4407
Practice Address - Street 1:70997 HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3249
Practice Address - Country:US
Practice Address - Phone:985-892-1550
Practice Address - Fax:985-892-4407
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist