Provider Demographics
NPI:1558702696
Name:IFEACHOR, AMANDA PETERS (PHARMD, MPH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:PETERS
Last Name:IFEACHOR
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, MPH
Mailing Address - Street 1:1481 W 10TH ST # 119
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-2144
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST # 119
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024542A183500000X
KY016031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist