Provider Demographics
NPI:1992435390
Name:LUNSFORD, AMANDA LEIGH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 OAK LEE DR
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-4871
Mailing Address - Country:US
Mailing Address - Phone:304-728-9041
Mailing Address - Fax:
Practice Address - Street 1:217 OAK LEE DR
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-4871
Practice Address - Country:US
Practice Address - Phone:304-728-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC30085096183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician