Provider Demographics
NPI:1780052886
Name:SMITH, AMANDA J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:SMITH
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 1:930 OLD STEESE HWY
Mailing Address - Street 2:PHARMACY
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3167
Mailing Address - Country:US
Mailing Address - Phone:907-459-4233
Mailing Address - Fax:
Practice Address - Street 1:930 OLD STEESE HWY
Practice Address - Street 2:PHARMACY
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3167
Practice Address - Country:US
Practice Address - Phone:907-459-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist