Provider Demographics
NPI:1578981429
Name:GILLESPIE, AMANDA (RPH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GILLESPIE
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 1:6501 GLENBROOK AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9586
Mailing Address - Country:US
Mailing Address - Phone:330-495-2795
Mailing Address - Fax:
Practice Address - Street 1:4200 KENT RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4325
Practice Address - Country:US
Practice Address - Phone:330-688-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist