=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003225269
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMELIA R NASH PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2014
-----------------------------------------------------
Last Update Date | 08/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901 STERLINGTON RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71203-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-323-0321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2407 FORT MIRO AVE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71201-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-614-3023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 020618
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------