Provider Demographics
NPI:1649562752
Name:KERI, AMANDA STACY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:STACY
Last Name:KERI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:STACY
Other - Last Name:COYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:121 MELVIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1409
Mailing Address - Country:US
Mailing Address - Phone:814-242-1964
Mailing Address - Fax:
Practice Address - Street 1:1516 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1752
Practice Address - Country:US
Practice Address - Phone:814-467-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist