Provider Demographics
NPI:1588731640
Name:WHITLEY, AMANDA BRADFORD (PHARMD)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BRADFORD
Last Name:WHITLEY
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 1:2212 NC HIGHWAY 210 W
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3750
Mailing Address - Country:US
Mailing Address - Phone:910-270-4320
Mailing Address - Fax:
Practice Address - Street 1:17230 US HIGHWAY 17 N
Practice Address - Street 2:STE 222
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-7465
Practice Address - Country:US
Practice Address - Phone:910-270-2223
Practice Address - Fax:910-270-2237
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist