MEDICARE: AMANDA J ANSPACH 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	26021952A	IN

General Provider Information

NPI Number	:	1992355606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA J ANSPACH PHARMD

Provider Business Mailing Address
First Line	:	7330 LIMA RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1130
Country	:	US
Telephone Number	:	260-489-6064
Fax Number	:	260-490-6544

Provider Business Practice Location Address
First Line	:	7330 LIMA RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1130
Country	:	US
Telephone Number	:	260-489-6064
Fax Number	:	260-490-6544

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

Provider Enumeration Date	:	09/14/2019
Last Update Date	:	09/14/2019

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Directions to “ AMANDA J ANSPACH PHARMD” Practice Location

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