Healthcare Provider Details

I. General information

NPI: 1861016438
Provider Name (Legal Business Name): AMANAH INVESTMENTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W CEDAR CREEK PKWY STE A-1
SEVEN POINTS TX
75143-8087
US

IV. Provider business mailing address

600 S PALESTINE ST
ATHENS TX
75751-3310
US

V. Phone/Fax

Practice location:
  • Phone: 903-432-3494
  • Fax: 903-432-3494
Mailing address:
  • Phone: 903-432-3494
  • Fax: 903-432-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LISA ANDERSON-KOCIAN
Title or Position: MEMBER
Credential: PHARMD
Phone: 903-681-3868