Healthcare Provider Details

I. General information

NPI: 1154492940
Provider Name (Legal Business Name): AMANDA K DEANER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 COURT ST
WILLIAMSBURG IA
52361
US

IV. Provider business mailing address

1982 78TH ST
BLAIRSTOWN IA
52209-9529
US

V. Phone/Fax

Practice location:
  • Phone: 319-668-1520
  • Fax:
Mailing address:
  • Phone: 319-454-6214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20140
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: