Provider Demographics
NPI:1427640622
Name:GARZA, AMANDA JAYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JAYNE
Last Name:GARZA
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 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1198
Mailing Address - Country:US
Mailing Address - Phone:765-932-7497
Mailing Address - Fax:
Practice Address - Street 1:3167 S STATE ROAD 3
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1318
Practice Address - Country:US
Practice Address - Phone:765-529-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025962A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist