Provider Demographics
NPI:1790022846
Name:VICKERY, AMY KATHERINE (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:VICKERY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2735
Mailing Address - Country:US
Mailing Address - Phone:615-302-4074
Mailing Address - Fax:615-302-4079
Practice Address - Street 1:4935 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2735
Practice Address - Country:US
Practice Address - Phone:615-302-4074
Practice Address - Fax:615-302-4079
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist