MEDICARE: DR. AMBERLY ROSA WYATT 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	17728	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194956177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBERLY ROSA WYATT PHARMD

Provider Business Mailing Address
First Line	:	841 S MAIN ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3763
Country	:	US
Telephone Number	:	336-228-6667
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 S MAIN ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3763
Country	:	US
Telephone Number	:	336-228-6667
Fax Number	:

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

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/07/2009

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