Provider Demographics
NPI:1740715325
Name:GOLAY, AMANDA
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:GOLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W LUGONIA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-9703
Mailing Address - Country:US
Mailing Address - Phone:909-844-6644
Mailing Address - Fax:
Practice Address - Street 1:24745 STEWART ST
Practice Address - Street 2:SHRYOCK HALL ROOM 234
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1719
Practice Address - Country:US
Practice Address - Phone:909-844-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist