Healthcare Provider Details

I. General information

NPI: 1043843071
Provider Name (Legal Business Name): AMANDA N FLYNT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA N BURKERT

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 E REZANOF DR
KODIAK AK
99615-6602
US

IV. Provider business mailing address

1911 E REZANOF DR
KODIAK AK
99615-6602
US

V. Phone/Fax

Practice location:
  • Phone: 907-481-5000
  • Fax: 907-481-5030
Mailing address:
  • Phone: 907-481-5000
  • Fax: 907-481-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number148329
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: