Provider Demographics
NPI:1356170252
Name:BRINGE, AMANDA ROSEMARY (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSEMARY
Last Name:BRINGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ROSEMARY
Other - Last Name:KRAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 AEROVISTA PL STE D
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8726
Mailing Address - Country:US
Mailing Address - Phone:866-239-3784
Mailing Address - Fax:
Practice Address - Street 1:720 AEROVISTA PL STE D
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8726
Practice Address - Country:US
Practice Address - Phone:866-239-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist