Provider Demographics
NPI:1144312026
Name:PERKINS, AMANDA JO (PHARM D)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JO
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 OREGON CT
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4573
Mailing Address - Country:US
Mailing Address - Phone:763-257-5413
Mailing Address - Fax:
Practice Address - Street 1:2165 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2707
Practice Address - Country:US
Practice Address - Phone:612-740-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist