Healthcare Provider Details

I. General information

NPI: 1033933452
Provider Name (Legal Business Name): AMANDA GILLISPIE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PLACE DEPT OF PHARMACY
MEMPHIS TN
38105
US

IV. Provider business mailing address

262 DANNY THOMAS PLACE DEPT OF PHARMACY
MEMPHIS TN
38105
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-8845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number8151900
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number42333
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: