MEDICARE: AMANDA THORNTON

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	PST.018181	LA

General Provider Information

NPI Number	:	1366810608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA THORNTON

Provider Business Mailing Address
First Line	:	303 N HOOD ST
Second Line	:
City	:	LAKE PROVIDENCE
State	:	LA
Zip	:	71254-2141
Country	:	US
Telephone Number	:	318-559-2433
Fax Number	:	318-559-2437

Provider Business Practice Location Address
First Line	:	303 N HOOD ST
Second Line	:
City	:	LAKE PROVIDENCE
State	:	LA
Zip	:	71254-2141
Country	:	US
Telephone Number	:	318-559-2433
Fax Number	:	318-559-2437

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

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	09/03/2015

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Directions to “ AMANDA THORNTON ” Practice Location

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