Provider Demographics
NPI:1396756003
Name:ANDERSON, AMY LEE (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 YELLOW STAR ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1709
Mailing Address - Country:US
Mailing Address - Phone:630-241-2945
Mailing Address - Fax:
Practice Address - Street 1:3035 BOOK RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4715
Practice Address - Country:US
Practice Address - Phone:630-904-4971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2884371701183500000X
IL051.302781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist