Healthcare Provider Details

I. General information

NPI: 1275785248
Provider Name (Legal Business Name): AMY LYNN LITTLE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WEST PRAIRIE AVE RITE AID PHARMACY
HAYDEN ID
83835
US

IV. Provider business mailing address

43 WEST PRAIRIE AVE RITE AID PHARMACY
HAYDEN ID
83835
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-2774
  • Fax:
Mailing address:
  • Phone: 208-772-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6198
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60020708
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: