Provider Demographics
NPI:1629485800
Name:FICK, AMANDA JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:FICK
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 1:12345 W 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4118
Mailing Address - Country:US
Mailing Address - Phone:720-628-1548
Mailing Address - Fax:
Practice Address - Street 1:1375 S BOULDER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2344
Practice Address - Country:US
Practice Address - Phone:303-673-1818
Practice Address - Fax:303-673-1981
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA19154183500000X
KS1-15571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist