Provider Demographics
NPI:1932480431
Name:MCDOUGAL, AMY ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ANNE
Last Name:MCDOUGAL
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 1:427 STEGELMEIER LN
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-9100
Mailing Address - Country:US
Mailing Address - Phone:208-359-8085
Mailing Address - Fax:
Practice Address - Street 1:1066 N YELLOWSTONE HWY
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5103
Practice Address - Country:US
Practice Address - Phone:208-390-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP51171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist