Provider Demographics
NPI:1952829004
Name:JAMES, AMANDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COUNTY ROAD 147
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:MS
Mailing Address - Zip Code:38873-9763
Mailing Address - Country:US
Mailing Address - Phone:662-760-3999
Mailing Address - Fax:
Practice Address - Street 1:615 BATTLEGROUND DR
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1314
Practice Address - Country:US
Practice Address - Phone:662-489-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE-010243OtherPHARMACIST LICENSE