Provider Demographics
NPI:1720369283
Name:WINSTON, AMANDA JANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:WINSTON
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 1:1331 SAVANNAH CIR
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-3001
Mailing Address - Country:US
Mailing Address - Phone:405-692-1882
Mailing Address - Fax:405-692-5914
Practice Address - Street 1:1331 SAVANNAH CIR
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068-3001
Practice Address - Country:US
Practice Address - Phone:405-692-1882
Practice Address - Fax:405-692-5914
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK14255OtherPHARMACY LICENSE NUMBER