Provider Demographics
NPI:1932415916
Name:ANDERSON, ERIN AMANDA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:AMANDA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:AMANDA
Other - Last Name:SHEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2317
Mailing Address - Country:US
Mailing Address - Phone:563-382-8765
Mailing Address - Fax:
Practice Address - Street 1:702 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101
Practice Address - Country:US
Practice Address - Phone:563-382-8765
Practice Address - Fax:563-382-1329
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48611183500000X
IA21744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist