Provider Demographics
NPI:1750671202
Name:PETRARCA, AMANDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PETRARCA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:LACHANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:245 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3527
Mailing Address - Country:US
Mailing Address - Phone:401-360-3300
Mailing Address - Fax:401-783-0045
Practice Address - Street 1:245 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3527
Practice Address - Country:US
Practice Address - Phone:401-360-3300
Practice Address - Fax:401-783-0045
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011103183500000X
RIRPH04755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist