Provider Demographics
NPI:1154926509
Name:BICKEL, AMY MARIE (CPHT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE
Last Name:BICKEL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17263 LEAD LINE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IL
Mailing Address - Zip Code:62615-9607
Mailing Address - Country:US
Mailing Address - Phone:217-652-5659
Mailing Address - Fax:
Practice Address - Street 1:620 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IL
Practice Address - Zip Code:62615-9784
Practice Address - Country:US
Practice Address - Phone:217-438-6141
Practice Address - Fax:217-438-3447
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.234701183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician