Provider Demographics
NPI:1356632954
Name:JUSTHAM, AMY LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:JUSTHAM
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 1:21509 SR 410 E
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-4190
Mailing Address - Country:US
Mailing Address - Phone:253-862-5000
Mailing Address - Fax:
Practice Address - Street 1:21509 SR 410 E
Practice Address - Street 2:SUITE 4
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-4190
Practice Address - Country:US
Practice Address - Phone:253-862-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60206419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist