Provider Demographics
NPI:1477833200
Name:HARMON, AMANDA DAWN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DAWN
Last Name:HARMON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CONN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IVEL
Mailing Address - State:KY
Mailing Address - Zip Code:41642-1804
Mailing Address - Country:US
Mailing Address - Phone:606-478-3784
Mailing Address - Fax:606-478-3788
Practice Address - Street 1:160 CONN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:IVEL
Practice Address - State:KY
Practice Address - Zip Code:41642-1804
Practice Address - Country:US
Practice Address - Phone:606-478-3784
Practice Address - Fax:606-478-3788
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist