Provider Demographics
NPI:1922660604
Name:GARAY, AMANDA MARIAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIAH
Last Name:GARAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIAH
Other - Last Name:BISEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:533 COUNTY ROAD 18
Mailing Address - Street 2:
Mailing Address - City:WRENSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:55797-9103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2855 CAMPUS DR STE 400
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2659
Practice Address - Country:US
Practice Address - Phone:763-577-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist