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General NPI Number Information
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NPI Number | 1922363704
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Entity Type | Individual
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Provider Name | AMANDA MOORE WALDEN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 310 N L ROGERS WELLS BLVD
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City | GLASGOW
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State | KY
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Zip | 42141-1300
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Country | US
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Telephone | 270-659-5599
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Fax | 270-659-5598
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Provider Business Mailing Address
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Address Line | 310 N L ROGERS WELLS BLVD
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City | GLASGOW
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State | KY
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Zip | 42141-1300
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Country | US
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Telephone | 270-659-5599
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Fax | 270-659-5598
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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 | 016013
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License Number State | KY
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