Provider Demographics
NPI:1598114365
Name:REARDON, AUTUMN AMBER (PHARMD, RPH)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:AMBER
Last Name:REARDON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:AMBER
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:1415 CURRAN HWY
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247
Mailing Address - Country:US
Mailing Address - Phone:413-664-4040
Mailing Address - Fax:413-664-7576
Practice Address - Street 1:1415 CURRAN HWY
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247
Practice Address - Country:US
Practice Address - Phone:413-664-4040
Practice Address - Fax:413-664-7576
Is Sole Proprietor?:No
Enumeration Date:2016-06-12
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH2360621835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric