Provider Demographics
NPI:1437759867
Name:NUGENT, AMBER LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEIGH
Last Name:NUGENT
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 1:10050 2425 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:IL
Mailing Address - Zip Code:61376-9261
Mailing Address - Country:US
Mailing Address - Phone:815-878-2352
Mailing Address - Fax:
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-3504
Practice Address - Country:US
Practice Address - Phone:815-626-6803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.286363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist