Provider Demographics
NPI:1861817538
Name:HOUTZ, AMANDA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:HOUTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:FIDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1112 W WYOMISSING BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-2259
Mailing Address - Country:US
Mailing Address - Phone:610-775-3409
Mailing Address - Fax:
Practice Address - Street 1:1112 W WYOMISSING BLVD
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-2259
Practice Address - Country:US
Practice Address - Phone:610-775-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist