1356170252 NPI number — AMANDA ROSEMARY BRINGE PHARMD.

Table of content: AMANDA ROSEMARY BRINGE PHARMD. (NPI 1356170252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356170252 NPI number — AMANDA ROSEMARY BRINGE PHARMD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINGE
Provider First Name:
AMANDA
Provider Middle Name:
ROSEMARY
Provider Name Prefix Text:
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:
KRAUSE
Provider Other First Name:
AMANDA
Provider Other Middle Name:
ROSEMARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356170252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 AEROVISTA PL STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-8726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-239-3784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 AEROVISTA PL STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-8726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-239-3784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2024

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:  64138 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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