MEDICARE: AMANDA JEAN KOUGH 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
1	183500000X	Pharmacist	RP0006538	WV

General Provider Information

NPI Number	:	1841329521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JEAN KOUGH PHARMD

Provider Business Mailing Address
First Line	:	2712 WELLTOWN SCHOOL RD
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25403-5807
Country	:	US
Telephone Number	:	717-404-5036
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 COWARDLY LION DR
Second Line	:	UNIT A
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6785
Country	:	US
Telephone Number	:	304-754-5800
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/24/2013

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