Provider Demographics
NPI:1942516190
Name:WEST, AMY NICHOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:NICHOLE
Last Name:WEST
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 1:1022 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-4102
Mailing Address - Country:US
Mailing Address - Phone:918-225-2200
Mailing Address - Fax:918-225-2201
Practice Address - Street 1:1022 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4102
Practice Address - Country:US
Practice Address - Phone:918-225-2200
Practice Address - Fax:918-225-2201
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49349183500000X
WV7456183500000X
OK15113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist