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General NPI Number Information
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NPI Number | 1437838703
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Entity Type | Individual
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Provider Name | AMY ELISE WORTKOETTER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 312 JONESTOWN RD
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City | WINSTON SALEM
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State | NC
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Zip | 27104-4621
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Country | US
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Telephone | 336-716-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 1638 SPOONBILL CT APT 2307
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City | WINSTON SALEM
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State | NC
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Zip | 27106-9915
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Country | US
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Telephone | 864-770-5239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 43968
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License Number State | SC
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