Provider Demographics
NPI:1407994908
Name:CALDWELL, AMANDA BROOKE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BROOKE
Last Name:CALDWELL
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 1:1100 STONEGATE DRIVE
Mailing Address - Street 2:LOT # 150
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832
Mailing Address - Country:US
Mailing Address - Phone:334-821-3549
Mailing Address - Fax:
Practice Address - Street 1:2055 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36110
Practice Address - Country:US
Practice Address - Phone:334-271-6457
Practice Address - Fax:334-271-6944
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist