Provider Demographics
NPI:1225404312
Name:FAUGHT, AMANDA LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:FAUGHT
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 1:235 COUNTY ROAD 1515
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-7590
Mailing Address - Country:US
Mailing Address - Phone:281-794-1137
Mailing Address - Fax:
Practice Address - Street 1:805 N DICKINSON DR
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1006
Practice Address - Country:US
Practice Address - Phone:903-683-7170
Practice Address - Fax:903-683-7996
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist