Healthcare Provider Details

I. General information

NPI: 1639650328
Provider Name (Legal Business Name): AMANDA NEYHART PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WASHINGTON AVE NW
WAGNER SD
57380-4300
US

IV. Provider business mailing address

111 WASHINGTON AVE NW
WAGNER SD
57380-4300
US

V. Phone/Fax

Practice location:
  • Phone: 605-384-3621
  • Fax: 605-384-5229
Mailing address:
  • Phone: 605-384-3621
  • Fax: 605-384-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5382
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: