Amy Beth Childerston
Individual provider Active NPI Pharmacist · Pella, IA
NPI 1740336155 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1740336155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 20262 (IA)
- Practice address
- 1610 Vermeer Rd E
Pella, IA 50219-7658 - Phone
- (641) 621-7470
- Fax
- (641) 621-7471
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20262 | IA | MD | Diagnostic Radiology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20262 | IA | Yes |
Addresses
Primary practice location
1610 Vermeer Rd E
Pella, IA 50219-7658
Mailing address
788 182ND Ave
Pella, IA 50219-7564
Other providers in Pella, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.