Provider Demographics
NPI:1912964859
Name:HEEREN, AMANDA LEIGH (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEIGH
Last Name:HEEREN
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 1:5510 VOLUNTEER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-2843
Mailing Address - Country:US
Mailing Address - Phone:573-355-4117
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5275
Practice Address - Country:US
Practice Address - Phone:573-814-3538
Practice Address - Fax:573-814-6535
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist