Provider Demographics
NPI:1205416229
Name:MYERS, AMY MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:MYERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 LUGABILL RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-9593
Mailing Address - Country:US
Mailing Address - Phone:419-358-8993
Mailing Address - Fax:
Practice Address - Street 1:112B E MAIN ST
Practice Address - Street 2:
Practice Address - City:PANDORA
Practice Address - State:OH
Practice Address - Zip Code:45877-8706
Practice Address - Country:US
Practice Address - Phone:419-384-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist