Provider Demographics
NPI:1447917604
Name:OUTLAW, AMY COOPER (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:COOPER
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 TECHNOLOGY PKWY S
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2928
Mailing Address - Country:US
Mailing Address - Phone:762-289-0300
Mailing Address - Fax:855-748-0572
Practice Address - Street 1:1 TECHNOLOGY PKWY S
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2928
Practice Address - Country:US
Practice Address - Phone:762-289-0300
Practice Address - Fax:855-748-0572
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA0166161835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric