Provider Demographics
NPI:1891078630
Name:WATERMEIER, AMANDA L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:L
Last Name:WATERMEIER
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 1:409 E 1ST NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1510
Mailing Address - Country:US
Mailing Address - Phone:217-556-6928
Mailing Address - Fax:
Practice Address - Street 1:409 E 1ST NORTH ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1510
Practice Address - Country:US
Practice Address - Phone:217-556-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist