Individual
AMANDA LACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
203 PHARMACY BLDG, CORVALLIS, OR 97331-8537
(541) 737-3424
Mailing address
2025 QUAIL RUN AVE, STAYTON, OR 97383-9537
(503) 800-1307
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/08/2025
Last updated
05/08/2025
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