Provider Demographics
NPI:1972192284
Name:ROWLAND, AMANDA BETH
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:BETH
Other - Last Name:DODDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 REBECCA RD
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:TX
Mailing Address - Zip Code:76557-3546
Mailing Address - Country:US
Mailing Address - Phone:254-722-8424
Mailing Address - Fax:
Practice Address - Street 1:1821 S VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-2118
Practice Address - Country:US
Practice Address - Phone:254-757-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician