=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912444043
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA NICOLE WESPER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2017
-----------------------------------------------------
Last Update Date | 01/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23743 JACKSON AVE
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-2099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-600-0692
-----------------------------------------------------
Fax | 951-894-4937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23743 JACKSON AVE
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-2099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-600-0692
-----------------------------------------------------
Fax | 951-894-4937
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 58187
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------