Amanda Rae Dale
Individual provider Active NPI Pharmacist · Norton, VA
NPI 1508469867 · NPPES record last updated Nov 19, 2020
Key facts
- NPI
- 1508469867
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0202210055 (VA)
- Practice address
- 1128 Park Ave NW
Norton, VA 24273-1720 - Phone
- (276) 679-4362
- NPI assigned
- Nov 19, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000043877 | TN | MD | Pharmacist |
| 0202210055 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Carolina CVS Pharmacy LLC | Past |
Accepting new patients | |
| Virginia CVS Pharmacy, L.L.C. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0000043877 | TN | |
| Pharmacist | 183500000X | 0202210055 | VA | Yes |
Addresses
Primary practice location
1128 Park Ave NW
Norton, VA 24273-1720
Mailing address
1128 Park Ave NW
Norton, VA 24273-1720
Phone (276) 679-4362
Other providers in Norton, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 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.