Provider Demographics
NPI:1043752850
Name:HARMON, AMANDA JOHNSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOHNSON
Last Name:HARMON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CAROL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 AUTUMN RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-6565
Mailing Address - Country:US
Mailing Address - Phone:336-789-0938
Mailing Address - Fax:
Practice Address - Street 1:364 N SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3532
Practice Address - Country:US
Practice Address - Phone:336-789-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15445183500000X
VA0202214860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist