Provider Demographics
NPI:1932509411
Name:PAGE, AMANDA (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FETLOCK DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-9042
Mailing Address - Country:US
Mailing Address - Phone:843-236-2600
Mailing Address - Fax:
Practice Address - Street 1:101 FETLOCK DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-9042
Practice Address - Country:US
Practice Address - Phone:843-236-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist