Provider Demographics
NPI:1215221403
Name:MAYER, AMANDA LEIGH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEIGH
Last Name:MAYER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:DREVYANKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:8501 W BROWN DEER RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2112
Mailing Address - Country:US
Mailing Address - Phone:414-355-3401
Mailing Address - Fax:414-355-3401
Practice Address - Street 1:8501 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2112
Practice Address - Country:US
Practice Address - Phone:414-355-3401
Practice Address - Fax:414-355-3401
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16163040183500000X
IA21303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist