Healthcare Provider Details

I. General information

NPI: 1134767916
Provider Name (Legal Business Name): AMANDA HEMMILA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S 6TH ST
BRAINERD MN
56401-3575
US

IV. Provider business mailing address

4993 BRENTWOOD RD
BAXTER MN
56425-8311
US

V. Phone/Fax

Practice location:
  • Phone: 218-829-0347
  • Fax: 218-829-4701
Mailing address:
  • Phone: 218-829-3623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number124586
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: