Provider Demographics
NPI:1720494636
Name:INGRAM, AMANDA C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:C
Last Name:INGRAM
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 1:1105 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:RANKIN
Mailing Address - State:TX
Mailing Address - Zip Code:79778
Mailing Address - Country:US
Mailing Address - Phone:432-693-2443
Mailing Address - Fax:
Practice Address - Street 1:1105 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:RANKIN
Practice Address - State:TX
Practice Address - Zip Code:79778
Practice Address - Country:US
Practice Address - Phone:432-693-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47972183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist