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General NPI Number Information
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NPI Number | 1932480431
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Entity Type | Individual
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Provider Name | AMY ANNE MCDOUGAL PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1066 N YELLOWSTONE HWY
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City | REXBURG
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State | ID
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Zip | 83440-5103
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Country | US
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Telephone | 208-390-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 427 STEGELMEIER LN
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City | REXBURG
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State | ID
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Zip | 83440-9100
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Country | US
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Telephone | 208-359-8085
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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 | P5117
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License Number State | ID
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