Provider Demographics
NPI:1538702659
Name:MATHEWS, AMANDA BRECK (RPH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BRECK
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22863 500TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-8830
Mailing Address - Country:US
Mailing Address - Phone:641-895-2413
Mailing Address - Fax:
Practice Address - Street 1:301 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1647
Practice Address - Country:US
Practice Address - Phone:641-664-2975
Practice Address - Fax:641-664-2856
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist