Individual
AMANDA GWEN KETTERER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
5510 HOWARD ST, SKOKIE, IL 60077-2620
(847) 588-7170
(847) 588-7060
Mailing address
123 W WASHINGTON AVE, 511, MADISON, WI 53703-2782
(608) 217-4546
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16218-040
WI
Other
Enumeration date
07/03/2011
Last updated
07/03/2011
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