Healthcare Provider Details

I. General information

NPI: 1124339791
Provider Name (Legal Business Name): AMY LEE MINNICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 SOUTH 7650 EAST CROW-NORTHERN CHEYENNE HOSPITAL
CROW AGENCY MT
59034
US

IV. Provider business mailing address

10110 S 7650 E CROW-NORTHERN CHEYENNE HOSPITAL
CROW AGENCY MT
59034
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3575
  • Fax: 406-638-3326
Mailing address:
  • Phone: 406-638-3575
  • Fax: 406-638-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10012
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: