Provider Demographics
NPI:1245737196
Name:HATHAWAY, AMY (RPH, BCGP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:RPH, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19512 W 97TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-3345
Mailing Address - Country:US
Mailing Address - Phone:913-486-7487
Mailing Address - Fax:
Practice Address - Street 1:19512 W 97TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220-3345
Practice Address - Country:US
Practice Address - Phone:913-486-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS124661835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric