Provider Demographics
NPI:1790103802
Name:TEMPLETON, AMANDA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:HARRELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2281 CLOVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2306
Mailing Address - Country:US
Mailing Address - Phone:336-773-0628
Mailing Address - Fax:336-777-1820
Practice Address - Street 1:2281 CLOVERDALE AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2306
Practice Address - Country:US
Practice Address - Phone:336-773-0628
Practice Address - Fax:336-777-1820
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist