Provider Demographics
NPI:1497972368
Name:DETWEILER, AMY LEE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LEE
Last Name:DETWEILER
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 1:49 SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4159
Mailing Address - Country:US
Mailing Address - Phone:724-437-5686
Mailing Address - Fax:412-678-7219
Practice Address - Street 1:210 9TH ST
Practice Address - Street 2:
Practice Address - City:GLASSPORT
Practice Address - State:PA
Practice Address - Zip Code:15045-1652
Practice Address - Country:US
Practice Address - Phone:412-678-5109
Practice Address - Fax:412-678-7219
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038950L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP038950LOtherPHARMACY LICENSE