Provider Demographics
NPI:1134402530
Name:NOLAN, AMANDA MARIE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1604
Mailing Address - Country:US
Mailing Address - Phone:518-292-1250
Mailing Address - Fax:518-292-1252
Practice Address - Street 1:41 VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-2183
Practice Address - Country:US
Practice Address - Phone:518-813-4543
Practice Address - Fax:518-813-4551
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY055873OtherLICENSE NUMBER