Healthcare Provider Details

I. General information

NPI: 1629485800
Provider Name (Legal Business Name): AMANDA JEAN FICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2014
Last Update Date: 03/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 S BOULDER RD
LOUISVILLE CO
80027-2344
US

IV. Provider business mailing address

12345 W 61ST AVE
ARVADA CO
80004-4118
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-1818
  • Fax: 303-673-1981
Mailing address:
  • Phone: 720-628-1548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA19154
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-15571
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: