Provider Demographics
NPI:1659657039
Name:RESH, AMANDA K (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:K
Last Name:RESH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-5024
Mailing Address - Country:US
Mailing Address - Phone:937-279-0468
Mailing Address - Fax:937-279-2262
Practice Address - Street 1:4855 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-5024
Practice Address - Country:US
Practice Address - Phone:937-279-0468
Practice Address - Fax:937-279-2262
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03226266183500000X
IN26022273A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist