Provider Demographics
NPI:1881042349
Name:ILENIN, AMANDA MARKOS (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARKOS
Last Name:ILENIN
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 1:1600 W LANE AVE
Mailing Address - Street 2:UNIT 429
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3956
Mailing Address - Country:US
Mailing Address - Phone:614-361-4892
Mailing Address - Fax:
Practice Address - Street 1:7500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8518
Practice Address - Country:US
Practice Address - Phone:614-544-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist