Provider Demographics
NPI:1134259336
Name:LOPOLITO, AMANDA NICOLE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:LOPOLITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 E ROWAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1232
Mailing Address - Country:US
Mailing Address - Phone:509-482-3057
Mailing Address - Fax:509-482-3058
Practice Address - Street 1:46 E ROWAN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1232
Practice Address - Country:US
Practice Address - Phone:509-482-3057
Practice Address - Fax:509-482-3058
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00069900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist