Provider Demographics
NPI:1346581873
Name:DAMON, AMY S (CPHT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:DAMON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4319
Mailing Address - Country:US
Mailing Address - Phone:610-457-4677
Mailing Address - Fax:
Practice Address - Street 1:4602 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4319
Practice Address - Country:US
Practice Address - Phone:610-457-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA560107010198496183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician