Amanda Dawn Hardisty, CPHT

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

CT1059 Issued in ID

Practice address

640 Highway 16
Emmett, ID 83617-9427

Phone

(208) 365-4128

NPI assigned

Mar 21, 2012

Last updated

Dec 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672358400000",
    "number": "1437424512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 W HIGHWAY 52",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836179738",
            "telephone_number": "208-272-9454",
            "fax_number": "208-272-9460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 HIGHWAY 16",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836179427",
            "telephone_number": "208-365-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDISTY",
        "first_name": "AMANDA",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "CPHT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "OR",
            "license": "CPT-0005101",
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "ID",
            "license": "CT1059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy Technician in Emmett, ID
• Providers in Emmett, ID by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.