Provider Demographics
NPI:1871141739
Name:CHASE, AMANDA L (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3326
Mailing Address - Country:US
Mailing Address - Phone:970-625-9420
Mailing Address - Fax:970-625-6185
Practice Address - Street 1:250 E VALLEY RD
Practice Address - Street 2:
Practice Address - City:EL JEBEL
Practice Address - State:CO
Practice Address - Zip Code:81623-7736
Practice Address - Country:US
Practice Address - Phone:970-963-3730
Practice Address - Fax:970-963-8565
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist