Provider Demographics
NPI:1013314905
Name:LATIMER, AMANDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:LATIMER
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 1:416 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3704
Mailing Address - Country:US
Mailing Address - Phone:845-331-0226
Mailing Address - Fax:845-331-5966
Practice Address - Street 1:416 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3704
Practice Address - Country:US
Practice Address - Phone:845-331-0226
Practice Address - Fax:845-331-5966
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist