Healthcare Provider Details

I. General information

NPI: 1629135009
Provider Name (Legal Business Name): AMY LYNN GOETTEMOELLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BUTLER STREET
FORT RECOVERY OH
45846
US

IV. Provider business mailing address

2180 ST. JOHNS RD.
MARIA STEIN OH
45860
US

V. Phone/Fax

Practice location:
  • Phone: 419-375-2323
  • Fax: 419-375-4488
Mailing address:
  • Phone: 419-925-1504
  • Fax: 419-375-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: