MEDICARE: DR. AMANDA COKE DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26933	TN

General Provider Information

NPI Number	:	1083926109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA COKE DPH

Provider Business Mailing Address
First Line	:	6565 SAINT ELMO RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-9448
Country	:	US
Telephone Number	:	901-383-1547
Fax Number	:

Provider Business Practice Location Address
First Line	:	6565 SAINT ELMO RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-9448
Country	:	US
Telephone Number	:	901-383-1547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	07/06/2010

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