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NPI Code Detail

MEDICARE: AMANDA FABER PHARMD

MEDICARE: AMANDA FABER 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
1183500000XPharmacistS022958AZ

General Provider Information

NPI Number : 1821507609
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA FABER PHARMD
Provider Business Mailing Address
First Line : 3908 N HILLINGTON LN
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86404-8724
Country : US
Telephone Number : 909-731-8090
Fax Number :
Provider Business Practice Location Address
First Line : 80 ACOMA BLVD N
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-6932
Country : US
Telephone Number : 928-680-4449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2017
Last Update Date : 09/25/2017

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Directions to “ AMANDA FABER PHARMD” Practice Location

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