Provider Demographics
NPI:1699291252
Name:HENSLEY, AMANDA TANNIELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:TANNIELLE
Last Name:HENSLEY
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 1:174 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1544
Mailing Address - Country:US
Mailing Address - Phone:606-595-8350
Mailing Address - Fax:
Practice Address - Street 1:116 N PINE ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1647
Practice Address - Country:US
Practice Address - Phone:606-337-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist