MEDICARE: DR. AMANDA M HOPPER PHARM.D.

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	PR6101	ME

General Provider Information

NPI Number	:	1467733295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA M HOPPER PHARM.D.

Provider Business Mailing Address
First Line	:	127 MARGINAL WAY
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-2470
Country	:	US
Telephone Number	:	207-771-5631
Fax Number	:	207-771-5645

Provider Business Practice Location Address
First Line	:	127 MARGINAL WAY
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-2470
Country	:	US
Telephone Number	:	207-771-5631
Fax Number	:	207-771-5645

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/07/2011

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