Healthcare Provider Details

I. General information

NPI: 1922370097
Provider Name (Legal Business Name): AMANDA L CHARLES PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

1601 E HIGHLAND AVE APT 1168
PHOENIX AZ
85016-4680
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-4555
  • Fax:
Mailing address:
  • Phone: 620-704-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18307
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: