MEDICARE: AMANDA JOHNSON WHITAKER

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	7581	SC

General Provider Information

NPI Number	:	1629326665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JOHNSON WHITAKER

Provider Business Mailing Address
First Line	:	109 W MANNING ST
Second Line	:
City	:	CHESNEE
State	:	SC
Zip	:	29323-1538
Country	:	US
Telephone Number	:	864-461-3123
Fax Number	:	864-703-2943

Provider Business Practice Location Address
First Line	:	109 W MANNING ST
Second Line	:
City	:	CHESNEE
State	:	SC
Zip	:	29323-1538
Country	:	US
Telephone Number	:	864-461-3123
Fax Number	:	864-703-2943

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

Provider Enumeration Date	:	08/23/2012
Last Update Date	:	08/23/2012

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Directions to “ AMANDA JOHNSON WHITAKER ” Practice Location

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