Provider Demographics
NPI:1154552214
Name:SMITH, AMANDA PUGH (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PUGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:PUGH
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400A S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-1555
Mailing Address - Country:US
Mailing Address - Phone:731-836-7211
Mailing Address - Fax:731-836-0344
Practice Address - Street 1:400A S CHURCH ST
Practice Address - Street 2:
Practice Address - City:HALLS
Practice Address - State:TN
Practice Address - Zip Code:38040-1555
Practice Address - Country:US
Practice Address - Phone:731-836-7211
Practice Address - Fax:731-836-0344
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist