Provider Demographics
NPI:1881005510
Name:AMES, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:AMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 FREEMAN LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-9616
Mailing Address - Country:US
Mailing Address - Phone:530-272-2496
Mailing Address - Fax:530-274-0632
Practice Address - Street 1:692 FREEMAN LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-9616
Practice Address - Country:US
Practice Address - Phone:530-272-2496
Practice Address - Fax:530-274-0632
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist