Healthcare Provider Details

I. General information

NPI: 1558755058
Provider Name (Legal Business Name): AMANDA SOWAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 WARWICK BLVD
NEWPORT NEWS VA
23601-3741
US

IV. Provider business mailing address

10818 WARWICK BLVD
NEWPORT NEWS VA
23601-3741
US

V. Phone/Fax

Practice location:
  • Phone: 757-596-7646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213771
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: