Active NPI
Amanda Mhoon
- Pharmacist
- Fayetteville, AR
National Provider Identifier
1619435377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD10743
- Practice address
- 3380 N Futrall Dr Ste 2
Fayetteville, AR 72703-4815 - Phone
- (479) 443-9200
- Fax
- (479) 443-9295
- NPI assigned
- Mar 12, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD10743 | AR | Primary |
Addresses
Primary practice location
3380 N Futrall Dr Ste 2
Fayetteville, AR 72703-4815
Mailing address
3380 N Futrall Dr Ste 2
Fayetteville, AR 72703-4815
Phone (479) 443-9200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD10743 | AR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Collier Drug Stores Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Lowell, AR
- NPI 1053165563
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552348800000",
"number": "1619435377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3380 N FUTRALL DR STE 2",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727034815",
"telephone_number": "479-443-9200",
"fax_number": "479-443-9295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3380 N FUTRALL DR STE 2",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727034815",
"telephone_number": "479-443-9200",
"fax_number": "479-443-9295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MHOON",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-12",
"last_updated": "2019-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD10743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.