Provider Demographics
NPI:1366854093
Name:SODERSTROM, AMY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:SODERSTROM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6434
Mailing Address - Country:US
Mailing Address - Phone:252-916-1426
Mailing Address - Fax:
Practice Address - Street 1:4101 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-9672
Practice Address - Country:US
Practice Address - Phone:252-527-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist