Provider Demographics
NPI:1205126919
Name:CURTIS, AMY SHAWN
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SHAWN
Last Name:CURTIS
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 1:1721 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-1342
Mailing Address - Country:US
Mailing Address - Phone:330-332-0023
Mailing Address - Fax:
Practice Address - Street 1:25 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413
Practice Address - Country:US
Practice Address - Phone:330-426-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03119132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist