Provider Demographics
NPI:1902230659
Name:ANDERSON, AMY ROSE (PHARM D)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ROSE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 HUFFINES BLVD
Mailing Address - Street 2:APT 2213
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6541
Mailing Address - Country:US
Mailing Address - Phone:630-730-6423
Mailing Address - Fax:
Practice Address - Street 1:7000 PARKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3535
Practice Address - Country:US
Practice Address - Phone:972-378-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist