Active NPI
Amanda Gwen Ketterer, PHARM.D.
- Pharmacist
- Skokie, IL
National Provider Identifier
1679860282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16218-040
- Practice address
- 5510 Howard St
Skokie, IL 60077-2620 - Phone
- (847) 588-7170
- Fax
- (847) 588-7060
- NPI assigned
- Jul 3, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16218-040 | WI | Primary |
Addresses
Primary practice location
5510 Howard St
Skokie, IL 60077-2620
Mailing address
123 W Washington Ave
511
Madison, WI 53703-2782
Phone (608) 217-4546
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16218-040 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309651200000",
"number": "1679860282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 W WASHINGTON AVE",
"address_2": "511",
"city": "MADISON",
"state": "WI",
"postal_code": "537032782",
"telephone_number": "608-217-4546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5510 HOWARD ST",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600772620",
"telephone_number": "847-588-7170",
"fax_number": "847-588-7060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTERER",
"first_name": "AMANDA",
"middle_name": "GWEN",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-03",
"last_updated": "2011-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "16218-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.