Provider Demographics
NPI:1144655036
Name:SMITH, AMANDA (PHARM D)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SMITH
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 1:303 2ND AVE
Mailing Address - Street 2:PO BOX 429
Mailing Address - City:CLARENCE
Mailing Address - State:IA
Mailing Address - Zip Code:52216-9756
Mailing Address - Country:US
Mailing Address - Phone:563-260-5429
Mailing Address - Fax:
Practice Address - Street 1:3600 BUSINESS HIGHWAY 151
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302
Practice Address - Country:US
Practice Address - Phone:319-377-7216
Practice Address - Fax:319-447-2552
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist