Individual
AMY TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
211 E CASCADE AVE, SISTERS, OR 97759-1140
(541) 549-6221
Mailing address
211 E CASCADE AVE, SISTERS, OR 97759-1140
(541) 549-6221
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0013212
OR
390200000X
Student in an Organized Health Care Education/Training Program
PI-0010431
OR
Other
Enumeration date
04/27/2011
Last updated
10/15/2012
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