Provider Demographics
NPI:1710212741
Name:KOLLMAR, AMBER S (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:S
Last Name:KOLLMAR
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:N112W16200 MEQUON RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3334
Mailing Address - Country:US
Mailing Address - Phone:262-253-0052
Mailing Address - Fax:855-772-6251
Practice Address - Street 1:N112W16200 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3334
Practice Address - Country:US
Practice Address - Phone:262-253-0052
Practice Address - Fax:855-772-6251
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15374-40183500000X, 1835P0018X
MI5302035309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist