Provider Demographics
NPI:1578964136
Name:LA, AMANDA QUE-ANH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:QUE-ANH
Last Name:LA
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 1:5082 STAGHORN DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8580
Mailing Address - Country:US
Mailing Address - Phone:714-489-1195
Mailing Address - Fax:
Practice Address - Street 1:525 OREGON ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3201
Practice Address - Country:US
Practice Address - Phone:707-648-2200
Practice Address - Fax:707-649-4045
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist