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General NPI Number Information
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NPI Number | 1821656075
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Entity Type | Individual
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Provider Name | AMAYA SERPA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 2325 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone | 203-427-7051
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Fax |
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Provider Business Mailing Address
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Address Line | 2098 TRUCKERSVILLE RD
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City | POCATELLO
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State | ID
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Zip | 83204-7405
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Country | US
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Telephone | 203-427-7051
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PCT.0011382
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PR70433
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 1835C0206X
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Taxonomy Name | Cardiology Pharmacist
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License Number | P6264
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License Number State | ID
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