Provider Demographics
NPI:1245710318
Name:PATSFIELD, AMANDA LEIGH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEIGH
Last Name:PATSFIELD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:PATSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2606 GREENUP RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-2048
Mailing Address - Country:US
Mailing Address - Phone:502-767-3721
Mailing Address - Fax:
Practice Address - Street 1:1250 PATROL RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-8670
Practice Address - Country:US
Practice Address - Phone:812-850-7207
Practice Address - Fax:812-256-7339
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-18
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26028059AOtherREGISTERED PHARMACIST
KY013704OtherREGISTERED PHARMACIST