Provider Demographics
NPI:1083210546
Name:PAGE, AMANDA CLAIRE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CLAIRE
Last Name:PAGE
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 1:1080 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1533
Mailing Address - Country:US
Mailing Address - Phone:815-562-6743
Mailing Address - Fax:
Practice Address - Street 1:1080 N 7TH ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1533
Practice Address - Country:US
Practice Address - Phone:815-562-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist