Provider Demographics
NPI:1356006100
Name:PHILLIPS, AMANDA LEA (RPH, PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 SPRAY AVE
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1147
Mailing Address - Country:US
Mailing Address - Phone:619-453-9526
Mailing Address - Fax:
Practice Address - Street 1:286 E 7TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2868
Practice Address - Country:US
Practice Address - Phone:520-364-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist