Provider Demographics
NPI:1982802054
Name:PUGH, AMANDA R (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:PUGH
Suffix:
Gender:
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 MORTON DR # 6787
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-4294
Mailing Address - Country:US
Mailing Address - Phone:678-637-1174
Mailing Address - Fax:
Practice Address - Street 1:80 CINEMA DR
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-2592
Practice Address - Country:US
Practice Address - Phone:706-635-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48406183500000X
GA023665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist