Provider Demographics
NPI:1710361985
Name:MIGITSCH, AMANDA CORRINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CORRINE
Last Name:MIGITSCH
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 1:1728 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4728
Mailing Address - Country:US
Mailing Address - Phone:704-342-1161
Mailing Address - Fax:
Practice Address - Street 1:1728 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4728
Practice Address - Country:US
Practice Address - Phone:704-342-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist