Provider Demographics
NPI:1265681191
Name:RENAUD-MUTART, AMY CHRISTINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CHRISTINE
Last Name:RENAUD-MUTART
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 1:201 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2996
Mailing Address - Country:US
Mailing Address - Phone:845-331-2070
Mailing Address - Fax:845-331-0012
Practice Address - Street 1:201 PLAZA RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2996
Practice Address - Country:US
Practice Address - Phone:845-331-2070
Practice Address - Fax:845-331-0012
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist