MEDICARE: MRS. AMANDA H DEAN PHARMD

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	021260	GA

General Provider Information

NPI Number	:	1134213952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA H DEAN PHARMD

Provider Business Mailing Address
First Line	:	RR 2 BOX 185C
Second Line	:
City	:	LEARY
State	:	GA
Zip	:	39862-9656
Country	:	US
Telephone Number	:	229-395-8319
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 OLD DAWSON RD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-1599
Country	:	US
Telephone Number	:	229-888-3530
Fax Number	:	229-888-5039

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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