Provider Demographics
NPI:1437789922
Name:VINCENT, AMANDA LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:VINCENT
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 1:6590 DOROTHYS DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4817
Mailing Address - Country:US
Mailing Address - Phone:563-340-2954
Mailing Address - Fax:
Practice Address - Street 1:2900 DEVILS GLEN RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3381
Practice Address - Country:US
Practice Address - Phone:563-332-2983
Practice Address - Fax:563-332-0804
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292775183500000X
IA20875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist