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General NPI Number Information
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NPI Number | 1407394992
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Entity Type | Organization
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Legal Business Name | BSA AMARILLO DIAGNOSTIC CLINIC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 6700 W 9TH AVE STE C
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City | AMARILLO
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State | TX
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Zip | 79106-1729
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Country | US
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Telephone | 806-356-5533
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Fax | 806-467-8651
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Provider Business Mailing Address
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Address Line | 6700 W 9TH AVE STE C
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City | AMARILLO
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State | TX
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Zip | 79106-1729
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Country | US
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Telephone | 806-356-5533
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Fax | 806-467-8651
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Authorized Official
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Title or Position | PHARMACIST/MANAGER
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Name | AMANDA L MORRISON
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Credential | RPH
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Telephone | 806-358-0331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 29430
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License Number State | TX
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