Provider Demographics
NPI:1982829222
Name:BOETTGER, KELLIE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:L
Last Name:BOETTGER
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 1:1461 230TH ST
Mailing Address - Street 2:
Mailing Address - City:SCHLESWIG
Mailing Address - State:IA
Mailing Address - Zip Code:51461-7515
Mailing Address - Country:US
Mailing Address - Phone:712-676-2299
Mailing Address - Fax:
Practice Address - Street 1:1426 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2053
Practice Address - Country:US
Practice Address - Phone:712-263-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist