Provider Demographics
NPI:1285929802
Name:EARY, AMANDA L (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:EARY
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 1:2030 NW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-2355
Mailing Address - Country:US
Mailing Address - Phone:580-354-7275
Mailing Address - Fax:580-354-7285
Practice Address - Street 1:2030 NW 82ND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2355
Practice Address - Country:US
Practice Address - Phone:580-354-7275
Practice Address - Fax:580-354-7285
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist