Provider Demographics
NPI:1720332166
Name:GUFFEY, AMANDA SUE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUE
Last Name:GUFFEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-5427
Mailing Address - Country:US
Mailing Address - Phone:608-362-1234
Mailing Address - Fax:608-362-2744
Practice Address - Street 1:1006 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-5427
Practice Address - Country:US
Practice Address - Phone:608-362-1234
Practice Address - Fax:608-362-2744
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33065700Medicaid
WI33065700Medicaid