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General NPI Number Information
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NPI Number | 1376950451
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Entity Type | Individual
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Provider Name | AMANDA NANTAIS
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Gender | Female
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 305 E LLANO ESTACADO BLVD
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City | CLOVIS
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State | NM
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Zip | 88101-3778
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Country | US
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Telephone | 575-762-3848
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Fax | 575-762-3840
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Provider Business Mailing Address
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Address Line | 305 E LLANO ESTACADO BLVD
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City | CLOVIS
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State | NM
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Zip | 88101-3778
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Country | US
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Telephone | 269-615-1485
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Fax | 575-762-3840
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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 | RP00008194
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License Number State | NM
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