Provider Demographics
NPI:1396321592
Name:ENSLEY, AMY JOSEPHINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:JOSEPHINE
Last Name:ENSLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JOSEPHINE
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-9320
Mailing Address - Country:US
Mailing Address - Phone:903-413-4005
Mailing Address - Fax:
Practice Address - Street 1:3520 W SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-0906
Practice Address - Country:US
Practice Address - Phone:417-862-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017005782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist