Healthcare Provider Details

I. General information

NPI: 1982100103
Provider Name (Legal Business Name): AMANDA KOLB EDWARDS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SILAS CREEK PKWY
WINSTON SALEM NC
27103-3013
US

IV. Provider business mailing address

3333 SILAS CREEK PKWY DEPT OF
WINSTON SALEM NC
27103-3013
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-9381
  • Fax: 336-277-7776
Mailing address:
  • Phone: 336-718-9381
  • Fax: 336-277-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21379
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number21379
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: