Provider Demographics
NPI:1598276214
Name:RICKEVICIUS, AMANDA K (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:RICKEVICIUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MARSH RD APT 17
Mailing Address - Street 2:
Mailing Address - City:WILLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06279-2115
Mailing Address - Country:US
Mailing Address - Phone:860-605-3114
Mailing Address - Fax:
Practice Address - Street 1:52 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2309
Practice Address - Country:US
Practice Address - Phone:860-747-5787
Practice Address - Fax:860-747-3311
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0014166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist