Healthcare Provider Details

I. General information

NPI: 1770745473
Provider Name (Legal Business Name): AMANDA M YARBERRY PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 POPLAR LEVEL RD STE 302
LOUISVILLE KY
40217-1395
US

IV. Provider business mailing address

2355 POPLAR LEVEL RD STE 302
LOUISVILLE KY
40217-1395
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-8088
  • Fax: 502-636-8078
Mailing address:
  • Phone: 502-636-8088
  • Fax: 502-636-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number011713
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: