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NPI Code Detail

MEDICARE: AMANDA KAY BLACK PHARMD

MEDICARE: AMANDA KAY BLACK 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
1183500000XPharmacistRPH0024510GA

General Provider Information

NPI Number : 1265715551
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA KAY BLACK PHARMD
Provider Business Mailing Address
First Line : 810 GA HIGHWAY 118 E
Second Line :
City : SMITHVILLE
State : GA
Zip : 31787-2804
Country : US
Telephone Number : 229-343-7159
Fax Number :
Provider Business Practice Location Address
First Line : 2351 DAWSON RD
Second Line :
City : ALBANY
State : GA
Zip : 31707-2435
Country : US
Telephone Number : 229-888-6166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2011
Last Update Date : 09/22/2011

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