Provider Demographics
NPI:1770989667
Name:AMERMAN, ATHENA M (PHARM D)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:M
Last Name:AMERMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:M
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:101 115TH ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-7976
Mailing Address - Country:US
Mailing Address - Phone:319-462-4314
Mailing Address - Fax:319-462-5742
Practice Address - Street 1:101 115TH ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-7976
Practice Address - Country:US
Practice Address - Phone:319-462-4314
Practice Address - Fax:319-462-5742
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24656183500000X
AZS021010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist