Provider Demographics
NPI:1922415025
Name:MCGRATH, AMY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476999 HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852-9738
Mailing Address - Country:US
Mailing Address - Phone:208-265-4490
Mailing Address - Fax:208-265-0794
Practice Address - Street 1:476999 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9738
Practice Address - Country:US
Practice Address - Phone:208-265-4490
Practice Address - Fax:208-265-0794
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist