Provider Demographics
NPI:1295955813
Name:AMBROSE, LYNDA ANNE (RPH)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:ANNE
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX V
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:PA
Mailing Address - Zip Code:18626
Mailing Address - Country:US
Mailing Address - Phone:570-946-4116
Mailing Address - Fax:570-946-4322
Practice Address - Street 1:MAIN AND KING STREET
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:PA
Practice Address - Zip Code:18626
Practice Address - Country:US
Practice Address - Phone:570-946-4116
Practice Address - Fax:570-946-4322
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10803183500000X
PARP029383L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist