Provider Demographics
NPI:1558541029
Name:RIDDLE, AMANDA LEANN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEANN
Last Name:RIDDLE
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 1:2438 1/2 JACK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-4902
Mailing Address - Country:US
Mailing Address - Phone:970-462-6162
Mailing Address - Fax:
Practice Address - Street 1:2438 1/2 JACK CREEK RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-4902
Practice Address - Country:US
Practice Address - Phone:970-462-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10515183500000X
CO17977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist