Provider Demographics
NPI:1134770092
Name:COONEY, AMANDA (RPH)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:COONEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 30TH ST APT 501B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7687
Mailing Address - Country:US
Mailing Address - Phone:406-207-4616
Mailing Address - Fax:
Practice Address - Street 1:1675 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3814
Practice Address - Country:US
Practice Address - Phone:541-485-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-63408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist