Provider Demographics
NPI:1558323626
Name:PATEL, AMANDA KAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KAY
Last Name:PATEL
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 1:1003 E BROADWAY ST
Mailing Address - Street 2:EASTGATE DRUG
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4971
Mailing Address - Country:US
Mailing Address - Phone:406-549-6163
Mailing Address - Fax:406-549-1786
Practice Address - Street 1:1003 E BROADWAY ST
Practice Address - Street 2:EASTGATE DRUG
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4971
Practice Address - Country:US
Practice Address - Phone:406-549-6163
Practice Address - Fax:406-549-1786
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT40201835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy