Provider Demographics
NPI:1306724174
Name:OETTINGER, JAMES AUGUST (RPH)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:AUGUST
Last Name:OETTINGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2201
Mailing Address - Country:US
Mailing Address - Phone:920-356-0148
Mailing Address - Fax:920-356-0401
Practice Address - Street 1:607 PARK AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2201
Practice Address - Country:US
Practice Address - Phone:920-356-0148
Practice Address - Fax:920-356-0401
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23140-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist