Healthcare Provider Details

I. General information

NPI: 1619796539
Provider Name (Legal Business Name): AMANDA KAY DWYER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 S NATIONAL AVE
SPRINGFIELD MO
65807-7304
US

IV. Provider business mailing address

3231 S NATIONAL AVE
SPRINGFIELD MO
65807-7304
US

V. Phone/Fax

Practice location:
  • Phone: 417-841-0116
  • Fax:
Mailing address:
  • Phone: 417-841-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2024040875
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: