Provider Demographics
NPI:1851675573
Name:WILLINGHAM, AMANDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:WILLINGHAM
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 1:3527 CHOUTEAU AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2915
Mailing Address - Country:US
Mailing Address - Phone:314-771-2900
Mailing Address - Fax:618-281-4124
Practice Address - Street 1:3527 CHOUTEAU AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2915
Practice Address - Country:US
Practice Address - Phone:314-771-2900
Practice Address - Fax:314-771-2955
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294470183500000X
MO2010025205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist