Individual
MRS. AMANDA DAWN HARDISTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
640 HIGHWAY 16, EMMETT, ID 83617-9427
(208) 365-4128
Mailing address
179 W HIGHWAY 52, EMMETT, ID 83617-9738
(208) 272-9454
(208) 272-9460
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
CPT-0005101
OR
183700000X
Pharmacy Technician
Primary
CT1059
ID
Other
Enumeration date
03/21/2012
Last updated
12/30/2022
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