Healthcare Provider Details

I. General information

NPI: 1053619023
Provider Name (Legal Business Name): AMANDA TRUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FORBES DR
MARTINSBURG WV
25404-0002
US

IV. Provider business mailing address

1169 HIGH GERMANY RD
WARFORDSBURG PA
17267-8421
US

V. Phone/Fax

Practice location:
  • Phone: 304-262-4697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0007489
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202210102
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: