Provider Demographics
NPI:1114044278
Name:AMBS, JANET LEA (TECH)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEA
Last Name:AMBS
Suffix:
Gender:F
Credentials:TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1429
Mailing Address - Country:US
Mailing Address - Phone:812-362-8619
Mailing Address - Fax:
Practice Address - Street 1:509 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1429
Practice Address - Country:US
Practice Address - Phone:812-362-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67000232A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN67000232AOtherTECH