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NPI Code Detail

MEDICARE: MRS. AMANDA HUDGINS FUNDERBURG PHARMD

MEDICARE: MRS. AMANDA HUDGINS FUNDERBURG 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
1183500000XPharmacist28050NC

General Provider Information

NPI Number : 1588131379
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA HUDGINS FUNDERBURG PHARMD
Provider Business Mailing Address
First Line : 1209 S COLLEGE ST UNIT 2438
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-4673
Country : US
Telephone Number : 704-589-0112
Fax Number :
Provider Business Practice Location Address
First Line : 2334 SOUTH BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5008
Country : US
Telephone Number : 704-523-8608
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2018
Last Update Date : 10/30/2018

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