Provider Demographics
NPI:1801431549
Name:SCHUTTEMEIER, AMANDA RAE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:SCHUTTEMEIER
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:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:EITZEN
Mailing Address - State:MN
Mailing Address - Zip Code:55931-0384
Mailing Address - Country:US
Mailing Address - Phone:563-380-8304
Mailing Address - Fax:
Practice Address - Street 1:137 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:MN
Practice Address - Zip Code:55974-1225
Practice Address - Country:US
Practice Address - Phone:507-498-5509
Practice Address - Fax:507-498-3632
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist