Provider Demographics
NPI:1831668540
Name:MARIANO, AMY NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:MARIANO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLUB CT
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1514
Mailing Address - Country:US
Mailing Address - Phone:570-856-1444
Mailing Address - Fax:
Practice Address - Street 1:RT 611 TANNERSVILLE PLAZA
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372
Practice Address - Country:US
Practice Address - Phone:570-619-5413
Practice Address - Fax:570-619-5462
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist