Provider Demographics
NPI:1518448414
Name:VANDERPOOL, AMY LINN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LINN
Last Name:VANDERPOOL
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 1:1401 W WAGONER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1461
Mailing Address - Country:US
Mailing Address - Phone:334-447-8685
Mailing Address - Fax:
Practice Address - Street 1:4724 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4704
Practice Address - Country:US
Practice Address - Phone:602-263-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist