Amanda Claire Clark, PHARMD
Individual provider Active NPI Pharmacist · Vidalia, GA
NPI 1013550086 · NPPES record last updated Oct 23, 2019
Key facts
- NPI
- 1013550086
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 023304 (GA)
- Practice address
- 305 Maple Dr
Vidalia, GA 30474-8908 - Phone
- (912) 538-0053
- NPI assigned
- Oct 23, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023304 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 023304 | GA | Yes |
Addresses
Primary practice location
305 Maple Dr
Vidalia, GA 30474-8908
Mailing address
305 Maple Dr
Vidalia, GA 30474-8908
Phone (912) 538-0053
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Vidalia | Direct |
Other providers in Vidalia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.