Provider Demographics
NPI:1891052700
Name:NORMAN, AMANDA RUTH
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RUTH
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19864 SOPHIA CT
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7569
Mailing Address - Country:US
Mailing Address - Phone:971-230-4108
Mailing Address - Fax:
Practice Address - Street 1:2497 SE BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1246
Practice Address - Country:US
Practice Address - Phone:503-669-4233
Practice Address - Fax:503-669-4238
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60546107183500000X
ORRPH - 0014810183500000X
ORRPH-00148101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist