Provider Demographics
NPI:1851667182
Name:HARRISON, AMANDA R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:R
Last Name:HARRISON
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 1:1171 W PENELOPE ST
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-2366
Mailing Address - Country:US
Mailing Address - Phone:208-922-2008
Mailing Address - Fax:
Practice Address - Street 1:16700 N MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7909
Practice Address - Country:US
Practice Address - Phone:208-465-3809
Practice Address - Fax:208-465-3806
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6940183500000X
WY3403183500000X
COPHA0019658183500000X
IDP6163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist