Provider Demographics
NPI:1629420971
Name:GARRISON, AMANDA WILLIAMS (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:WILLIAMS
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 MONTAUK TRL SE
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-8736
Mailing Address - Country:US
Mailing Address - Phone:256-464-9949
Mailing Address - Fax:256-464-9950
Practice Address - Street 1:112A CELTIC DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1800
Practice Address - Country:US
Practice Address - Phone:256-464-9949
Practice Address - Fax:256-464-9950
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist