Provider Demographics
NPI:1376950451
Name:NANTAIS, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NANTAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:NANTAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:305 E LLANO ESTACADO BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3778
Mailing Address - Country:US
Mailing Address - Phone:269-615-1485
Mailing Address - Fax:575-762-3840
Practice Address - Street 1:305 E LLANO ESTACADO BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3778
Practice Address - Country:US
Practice Address - Phone:575-762-3848
Practice Address - Fax:575-762-3840
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist