Provider Demographics
NPI:1992359236
Name:STALLINGS, AMANDA JOY (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:STALLINGS
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 1:1750 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2503
Mailing Address - Country:US
Mailing Address - Phone:831-476-0400
Mailing Address - Fax:
Practice Address - Street 1:1750 41ST AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2503
Practice Address - Country:US
Practice Address - Phone:831-476-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist