Provider Demographics
NPI:1619266822
Name:PRIDDY, AMANDA DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:PRIDDY
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 1:101-A ROOSEVELT BLVD
Mailing Address - Street 2:RITE AID PHARMACY #00141
Mailing Address - City:ELEANOR
Mailing Address - State:WV
Mailing Address - Zip Code:25070
Mailing Address - Country:US
Mailing Address - Phone:304-586-9064
Mailing Address - Fax:304-586-9687
Practice Address - Street 1:101-A ROOSEVELT BLVD
Practice Address - Street 2:RITE AID PHARMACY #00141
Practice Address - City:ELEANOR
Practice Address - State:WV
Practice Address - Zip Code:25070
Practice Address - Country:US
Practice Address - Phone:304-586-9064
Practice Address - Fax:304-586-9687
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist