Provider Demographics
NPI:1568909679
Name:AMHERST PHARMACY LLC
Entity Type:Organization
Organization Name:AMHERST PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:IOANNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKITAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-256-1716
Mailing Address - Street 1:381 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2391
Mailing Address - Country:US
Mailing Address - Phone:413-253-0387
Mailing Address - Fax:413-253-0389
Practice Address - Street 1:19 MONTAGUE RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1027
Practice Address - Country:US
Practice Address - Phone:413-992-2145
Practice Address - Fax:413-992-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS90076333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167524OtherPK