Provider Demographics
NPI:1194432419
Name:ANDERSON, AMBER (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ANDERSON
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 1:211 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6205
Mailing Address - Country:US
Mailing Address - Phone:435-619-1710
Mailing Address - Fax:
Practice Address - Street 1:1849 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6508
Practice Address - Country:US
Practice Address - Phone:435-879-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23067183500000X
UT8393275-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist