Provider Demographics
NPI:1083208995
Name:WALSH, AMANDA KATHLEEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KATHLEEN
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 WILDFLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9241
Mailing Address - Country:US
Mailing Address - Phone:630-818-5553
Mailing Address - Fax:
Practice Address - Street 1:1299 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1603
Practice Address - Country:US
Practice Address - Phone:630-548-2057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist