Provider Demographics
NPI:1710983168
Name:DEWEIN, AMY CAROLE (RPH, PHARMD, MHS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CAROLE
Last Name:DEWEIN
Suffix:
Gender:F
Credentials:RPH, PHARMD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SOMERSET DOWNS
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1007
Mailing Address - Country:US
Mailing Address - Phone:314-308-0911
Mailing Address - Fax:
Practice Address - Street 1:25 SOMERSET DOWNS
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1007
Practice Address - Country:US
Practice Address - Phone:314-308-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-040259183500000X
IA17353183500000X
MO2005003710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist