Individual
AMANDA VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
134 S MAIN ST, COLUMBIA, IL 62236-2306
(618) 281-5135
(618) 281-4181
Mailing address
134 S MAIN ST, COLUMBIA, IL 62236-2306
(618) 281-5135
(618) 281-4181
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051297307
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
833533306-001
—
IL
Enumeration date
03/18/2021
Last updated
03/18/2021
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