Provider Demographics
NPI:1770246316
Name:LAWRENCE, AMANDA EILEEN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:EILEEN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-9645
Mailing Address - Country:US
Mailing Address - Phone:814-774-2467
Mailing Address - Fax:
Practice Address - Street 1:9125 RIDGE RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-9645
Practice Address - Country:US
Practice Address - Phone:814-774-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist