Provider Demographics
NPI:1154819746
Name:BADGLEY, AMY DAWN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DAWN
Last Name:BADGLEY
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 1:1212 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-2834
Mailing Address - Country:US
Mailing Address - Phone:417-673-5623
Mailing Address - Fax:417-673-5409
Practice Address - Street 1:1212 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2834
Practice Address - Country:US
Practice Address - Phone:417-673-5623
Practice Address - Fax:417-673-5409
Is Sole Proprietor?:No
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist