Provider Demographics
NPI:1124339791
Name:MINNICK, AMY LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LEE
Last Name:MINNICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 S 7650 E
Mailing Address - Street 2:CROW-NORTHERN CHEYENNE HOSPITAL
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59034
Mailing Address - Country:US
Mailing Address - Phone:406-638-3575
Mailing Address - Fax:406-638-3326
Practice Address - Street 1:10110 SOUTH 7650 EAST
Practice Address - Street 2:CROW-NORTHERN CHEYENNE HOSPITAL
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59034
Practice Address - Country:US
Practice Address - Phone:406-638-3575
Practice Address - Fax:406-638-3326
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10012OtherPHARMACIST LICENSE