Healthcare Provider Details

I. General information

NPI: 1225404312
Provider Name (Legal Business Name): AMANDA LYNN FAUGHT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 N DICKINSON DR
RUSK TX
75785-1006
US

IV. Provider business mailing address

235 COUNTY ROAD 1515
JACKSONVILLE TX
75766-7590
US

V. Phone/Fax

Practice location:
  • Phone: 903-683-7170
  • Fax: 903-683-7996
Mailing address:
  • Phone: 281-794-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56977
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: