Provider Demographics
NPI:1851706998
Name:PRATT, AMANDA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2611
Mailing Address - Country:US
Mailing Address - Phone:612-302-8740
Mailing Address - Fax:612-302-8923
Practice Address - Street 1:701 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2611
Practice Address - Country:US
Practice Address - Phone:612-302-8740
Practice Address - Fax:612-302-8923
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist