Provider Demographics
NPI:1003230178
Name:NOWAKOWSKI, AMANDA LOUISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LOUISE
Last Name:NOWAKOWSKI
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 1:221 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 ROUTE 940
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1325
Practice Address - Country:US
Practice Address - Phone:570-839-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist