Basic Information
| Provider Information | |||||||||
| NPI: | 1477081776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JANISCH | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 NW 58TH ST UNIT 618 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981076110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058812351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1025 MARSH ST | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076254031 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2017 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6401 | SD | N | Pharmacy Service Providers | Pharmacist | 183500000X | PH60677369 | WA | N | Pharmacy Service Providers | Pharmacist | 183500000X | 123230 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.