Provider Demographics
NPI:1437462561
Name:UNDERWOOD, AMY (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6995
Mailing Address - Country:US
Mailing Address - Phone:866-233-6564
Mailing Address - Fax:208-395-7744
Practice Address - Street 1:1211 W MYRTLE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6995
Practice Address - Country:US
Practice Address - Phone:866-233-6564
Practice Address - Fax:208-395-7744
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist