Provider Demographics
NPI:1255755161
Name:JOHNSON, AMANDA PETERS (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PETERS
Last Name:JOHNSON
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 1:4400 EMPEROR BLVD
Mailing Address - Street 2:DEPARTMENT OF PHARMACY-- CAMP CLINIC
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8418
Mailing Address - Country:US
Mailing Address - Phone:984-974-6524
Mailing Address - Fax:
Practice Address - Street 1:4400 EMPEROR BLVD
Practice Address - Street 2:DEPARTMENT OF PHARMACY-- CAMP CLINIC
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8418
Practice Address - Country:US
Practice Address - Phone:984-974-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist