Healthcare Provider Details

I. General information

NPI: 1003409715
Provider Name (Legal Business Name): AMANDA ALYSE KEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

1642 HARVARD AVE
CLOVIS CA
93612-2615
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-4000
  • Fax:
Mailing address:
  • Phone: 559-960-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: