=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194432419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER ANDERSON PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2022
-----------------------------------------------------
Last Update Date | 11/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1849 W SUNSET BLVD
-----------------------------------------------------
City | SAINT GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84770-6508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-879-5165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 W CENTER ST
-----------------------------------------------------
City | IVINS
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84738-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-619-1710
-----------------------------------------------------
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 | 23067
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8393275-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------