Provider Demographics
NPI:1336104090
Name:HERMAN, AMY SUE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUE
Last Name:HERMAN
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 1:526 MAIN STREET
Mailing Address - Street 2:ROSENKRANS PHARMACY
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103
Mailing Address - Country:US
Mailing Address - Phone:585-798-1650
Mailing Address - Fax:585-798-9632
Practice Address - Street 1:526 MAIN STREET
Practice Address - Street 2:ROSENKRANS PHARMACY
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103
Practice Address - Country:US
Practice Address - Phone:585-798-1650
Practice Address - Fax:585-798-9632
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist