Amanda Bourdon, PHARMD
Individual provider Active NPI Pharmacist · Macomb, IL
NPI 1336740729 · NPPES record last updated Nov 5, 2020
Key facts
- NPI
- 1336740729
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051301705 (IL)
- Practice address
- 1730 E Jackson St
Macomb, IL 61455-2531 - Phone
- (309) 833-1456
- NPI assigned
- Nov 3, 2020
- 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 |
|---|---|---|---|
| 051301705 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051301705 | IL | Yes |
Addresses
Primary practice location
1730 E Jackson St
Macomb, IL 61455-2531
Mailing address
112 James Dr
Macomb, IL 61455-3302
Phone (847) 863-5502
Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2020. 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.