Provider Demographics
NPI:1225750235
Name:CRUSCO, AMANDA (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CRUSCO
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 1:56205 CAROUSEL LN
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-2462
Mailing Address - Country:US
Mailing Address - Phone:978-400-1449
Mailing Address - Fax:
Practice Address - Street 1:246 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3310
Practice Address - Country:US
Practice Address - Phone:978-534-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist