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NPI Code Detail

MEDICARE: AMANDA MICHELLE WAITE RPH

MEDICARE: AMANDA MICHELLE WAITE RPH
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
1183500000XPharmacistRPH51239CA

General Provider Information

NPI Number : 1396026340
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MICHELLE WAITE RPH
Provider Business Mailing Address
First Line : 11 RACCOON DR
Second Line :
City : NOVATO
State : CA
Zip : 94949-6683
Country : US
Telephone Number : 415-462-8032
Fax Number :
Provider Business Practice Location Address
First Line : 830 3RD ST
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94901-3302
Country : US
Telephone Number : 415-455-9919
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2011
Last Update Date : 09/05/2011

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Directions to “ AMANDA MICHELLE WAITE RPH” Practice Location

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