Provider Demographics
NPI:1831467414
Name:OEHLERT, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:OEHLERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-0510
Mailing Address - Country:US
Mailing Address - Phone:208-623-8485
Mailing Address - Fax:208-623-3400
Practice Address - Street 1:31964 N. FIFTH AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:ID
Practice Address - Zip Code:83869
Practice Address - Country:US
Practice Address - Phone:208-623-8485
Practice Address - Fax:208-623-3400
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCS15411183500000X
IDP6360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist