Provider Demographics
NPI:1891010260
Name:CRUZ, AMELIA (RPH)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-8107
Mailing Address - Country:US
Mailing Address - Phone:845-639-4952
Mailing Address - Fax:
Practice Address - Street 1:312 ROUTE 59
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2732
Practice Address - Country:US
Practice Address - Phone:845-353-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist