Amanda Marie Bales, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

21101-40 Issued in WI

Practice address

1515 W Paradise Dr
West Bend, WI 53095-9794

Phone

(262) 334-9860

Fax

(262) 334-4631

NPI assigned

Nov 22, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda Marie Owen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1720745920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 W PARADISE DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959794",
            "telephone_number": "262-334-9860",
            "fax_number": "262-334-4631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 W PARADISE DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959794",
            "telephone_number": "262-334-9860",
            "fax_number": "262-334-4631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALES",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-22",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "21101-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "OWEN",
            "middle_name": "MARIE",
            "credential": "PHARMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pharmacist in West Bend, WI
• Providers in West Bend, WI by specialty
• Pharmacist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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.