Provider Demographics
NPI:1275785248
Name:LITTLE, AMY LYNN (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WEST PRAIRIE AVE
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835
Mailing Address - Country:US
Mailing Address - Phone:208-772-2774
Mailing Address - Fax:
Practice Address - Street 1:43 WEST PRAIRIE AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835
Practice Address - Country:US
Practice Address - Phone:208-772-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6198183500000X
WAPH60020708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist