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General NPI Number Information
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NPI Number | 1023504651
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Entity Type | Individual
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Provider Name | AMANDA WRAY RPH
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Gender | Female
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-782-2990
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Fax | 208-782-2931
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Provider Business Mailing Address
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Address Line | 1585 KATES WAY
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City | POCATELLO
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State | ID
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Zip | 83204-4606
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Country | US
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Telephone | 208-604-6660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P7045
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License Number State | ID
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