Provider Demographics
NPI:1497245914
Name:WITTWER, EMILY BROOKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BROOKE
Last Name:WITTWER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:BROOKE
Other - Last Name:MITCHELTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:900 MCKENDREE LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-2646
Mailing Address - Country:US
Mailing Address - Phone:678-863-8410
Mailing Address - Fax:
Practice Address - Street 1:220 HIGHWAY 334
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30530-4835
Practice Address - Country:US
Practice Address - Phone:706-335-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist