Provider Demographics
NPI:1437838703
Name:WORTKOETTER, AMY ELISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELISE
Last Name:WORTKOETTER
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 1:1638 SPOONBILL CT APT 2307
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-9915
Mailing Address - Country:US
Mailing Address - Phone:864-770-5239
Mailing Address - Fax:
Practice Address - Street 1:312 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4621
Practice Address - Country:US
Practice Address - Phone:336-716-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist