Provider Demographics
NPI:1225563505
Name:CLOUGH, AMANDA R (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:CLOUGH
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 1:1504 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2714
Mailing Address - Country:US
Mailing Address - Phone:785-232-8550
Mailing Address - Fax:785-232-8560
Practice Address - Street 1:1504 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2714
Practice Address - Country:US
Practice Address - Phone:785-232-8550
Practice Address - Fax:785-232-8560
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1100435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist