MEDICARE: DR. AMANDA L HALL PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS48966	FL

General Provider Information

NPI Number	:	1215379177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA L HALL PHARMD

Provider Business Mailing Address
First Line	:	1080 NW SANTA FE BLVD
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-8404
Country	:	US
Telephone Number	:	386-454-4259
Fax Number	:

Provider Business Practice Location Address
First Line	:	1080 NW SANTA FE BLVD
Second Line	:
City	:	HIGH SPRINGS
State	:	FL
Zip	:	32643-8404
Country	:	US
Telephone Number	:	386-454-4259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2013
Last Update Date	:	07/20/2013

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