Provider Demographics
NPI:1437759859
Name:LIPSCOMB, AMANDA LEWIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEWIS
Last Name:LIPSCOMB
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 1:303 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1203
Mailing Address - Country:US
Mailing Address - Phone:434-336-1239
Mailing Address - Fax:
Practice Address - Street 1:303 MARKET DR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1203
Practice Address - Country:US
Practice Address - Phone:434-336-1239
Practice Address - Fax:434-336-0080
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist