Provider Demographics
NPI:1023305091
Name:EWART, AMBER L (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:EWART
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 N ESTY DR # B
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9378
Mailing Address - Country:US
Mailing Address - Phone:907-745-7331
Mailing Address - Fax:
Practice Address - Street 1:1800 E PARKS HWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7353
Practice Address - Country:US
Practice Address - Phone:907-631-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841448743OtherNPI
1841448743OtherNPI