Provider Demographics
NPI:1790068617
Name:BLAIR, AMY ANH-THU (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ANH-THU
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ANH-THU
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2640 W WESTCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810
Mailing Address - Country:US
Mailing Address - Phone:417-520-0607
Mailing Address - Fax:417-520-0608
Practice Address - Street 1:1500 E SUNSHINE ST
Practice Address - Street 2:SUITE 148
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-520-0607
Practice Address - Fax:417-520-0608
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010023016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist