Provider Demographics
NPI:1255878757
Name:LANDERS, AMBER ADELE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ADELE
Last Name:LANDERS
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 1:245 CHENERY ST
Mailing Address - Street 2:APT 1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2759
Mailing Address - Country:US
Mailing Address - Phone:417-773-7376
Mailing Address - Fax:
Practice Address - Street 1:245 CHENERY ST
Practice Address - Street 2:APT 1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2759
Practice Address - Country:US
Practice Address - Phone:417-773-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8041664-1701183500000X
MO2011024500183500000X
CA74560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist