Provider Demographics
NPI:1568952836
Name:HOOVEN, AMY GILLESPIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GILLESPIE
Last Name:HOOVEN
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 1:60 MICHELLE LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8290
Mailing Address - Country:US
Mailing Address - Phone:540-353-6133
Mailing Address - Fax:
Practice Address - Street 1:4841 WILLIAMSON RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2331
Practice Address - Country:US
Practice Address - Phone:540-265-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist