Healthcare Provider Details

I. General information

NPI: 1841997665
Provider Name (Legal Business Name): AMANDA ADKINS BLAIR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S KY 7
SANDY HOOK KY
41171-8132
US

IV. Provider business mailing address

PO BOX 492
SANDY HOOK KY
41171-0492
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-4041
  • Fax: 606-738-4030
Mailing address:
  • Phone: 606-738-4041
  • Fax: 606-738-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019992
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: