Provider Demographics
NPI:1992283931
Name:CALVERT, AMANDA STEVENS (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:STEVENS
Last Name:CALVERT
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 1:10250 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-3132
Mailing Address - Country:US
Mailing Address - Phone:336-804-6051
Mailing Address - Fax:336-861-0212
Practice Address - Street 1:10250 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3132
Practice Address - Country:US
Practice Address - Phone:336-804-6051
Practice Address - Fax:336-861-0212
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist