Provider Demographics
NPI:1811589336
Name:KAMPWERTH, ALYSSA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:M
Last Name:KAMPWERTH
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 1:117 CLINTONIAN PLZ
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1501
Mailing Address - Country:US
Mailing Address - Phone:618-526-8040
Mailing Address - Fax:618-526-8072
Practice Address - Street 1:117 CLINTONIAN PLZ
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1501
Practice Address - Country:US
Practice Address - Phone:618-526-8040
Practice Address - Fax:618-526-8072
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist