Provider Demographics
NPI:1548854797
Name:GUINN, AMANDA LEA KIMBERLY
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEA KIMBERLY
Last Name:GUINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 LAKE RUN CIR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7500
Mailing Address - Country:US
Mailing Address - Phone:205-552-2784
Mailing Address - Fax:256-237-7537
Practice Address - Street 1:1926 BYNUM BLVD
Practice Address - Street 2:
Practice Address - City:EASTABOGA
Practice Address - State:AL
Practice Address - Zip Code:36260-5431
Practice Address - Country:US
Practice Address - Phone:256-237-7533
Practice Address - Fax:256-237-7537
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist