Provider Demographics
NPI:1417373978
Name:BUTKIEWICZ, AMANDA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:BUTKIEWICZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:RAMSDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:64 LEPAGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3866
Mailing Address - Country:US
Mailing Address - Phone:413-841-0216
Mailing Address - Fax:
Practice Address - Street 1:425 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-3816
Practice Address - Country:US
Practice Address - Phone:203-639-8166
Practice Address - Fax:203-639-7207
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist