Provider Demographics
NPI:1275657082
Name:MABE, AMY MICHELE
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELE
Last Name:MABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 297
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263
Mailing Address - Country:US
Mailing Address - Phone:276-346-1381
Mailing Address - Fax:
Practice Address - Street 1:CHAPPEL GARDEN DR
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263
Practice Address - Country:US
Practice Address - Phone:276-346-2180
Practice Address - Fax:276-346-2544
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist