1588731640 NPI number — MS. AMANDA BRADFORD WHITLEY PHARMD

Table of content: MS. AMANDA BRADFORD WHITLEY PHARMD (NPI 1588731640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588731640 NPI number — MS. AMANDA BRADFORD WHITLEY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITLEY
Provider First Name:
AMANDA
Provider Middle Name:
BRADFORD
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588731640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2212 NC HIGHWAY 210 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28443-3750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-270-4320
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17230 US HIGHWAY 17 N
Provider Second Line Business Practice Location Address:
STE 222
Provider Business Practice Location Address City Name:
HAMPSTEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28443-7465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-270-2223
Provider Business Practice Location Address Fax Number:
910-270-2237
Provider Enumeration Date:
11/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  16415 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)