Provider Demographics
NPI:1003225269
Name:NASH, AMELIA R (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:R
Last Name:NASH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 FORT MIRO AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2916
Mailing Address - Country:US
Mailing Address - Phone:318-614-3023
Mailing Address - Fax:
Practice Address - Street 1:2901 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2513
Practice Address - Country:US
Practice Address - Phone:318-323-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist