Healthcare Provider Details

I. General information

NPI: 1922314160
Provider Name (Legal Business Name): AMY VAN GORP PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LINCOLN CIR SE SUITE 100
ORANGE CITY IA
51041-1836
US

IV. Provider business mailing address

1000 LINCOLN CIR SE SUITE 100
ORANGE CITY IA
51041-1836
US

V. Phone/Fax

Practice location:
  • Phone: 712-737-2000
  • Fax:
Mailing address:
  • Phone: 712-737-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number20572
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: