Provider Demographics
NPI:1437697901
Name:GADDIS, AMY (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GADDIS
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 1:1080 ALLEN RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9204
Mailing Address - Country:US
Mailing Address - Phone:207-252-5521
Mailing Address - Fax:
Practice Address - Street 1:1080 ALLEN RD APT 2C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-9204
Practice Address - Country:US
Practice Address - Phone:207-252-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist