Provider Demographics
NPI:1124678271
Name:MCGEHEE, AMANDA MARIE (PHARM D)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:MCGEHEE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-9413
Mailing Address - Country:US
Mailing Address - Phone:208-848-6174
Mailing Address - Fax:
Practice Address - Street 1:523 THAIN RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5530
Practice Address - Country:US
Practice Address - Phone:208-743-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8523183500000X
WAPH60960349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist