Provider Demographics
NPI:1790293579
Name:ROBINSON, AMANDA DIANE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DIANE
Last Name:ROBINSON
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 1:13 STONEGATE CIR
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-2445
Mailing Address - Country:US
Mailing Address - Phone:413-478-5400
Mailing Address - Fax:
Practice Address - Street 1:300 COOLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01128-1801
Practice Address - Country:US
Practice Address - Phone:413-782-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPI162065183700000X
MAPH239027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician