Individual
AMANDA KHAMSOUTHAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1700 E 19TH ST, THE DALLES, OR 97058-3317
(541) 296-7526
Mailing address
1700 E 19TH ST, THE DALLES, OR 97058-3317
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0020259
OR
Other
Enumeration date
04/29/2025
Last updated
05/05/2025
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