Provider Demographics
NPI:1053657486
Name:OVERSTREET, AMY (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 N H ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-4520
Mailing Address - Country:US
Mailing Address - Phone:805-735-4388
Mailing Address - Fax:805-735-4721
Practice Address - Street 1:729 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-4520
Practice Address - Country:US
Practice Address - Phone:805-735-4388
Practice Address - Fax:805-735-4721
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist