Provider Demographics
NPI:1649874173
Name:BACH, AMY LAUREN
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LAUREN
Last Name:BACH
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 1:1137 STATE ROUTE 131
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2715
Mailing Address - Country:US
Mailing Address - Phone:513-831-8225
Mailing Address - Fax:513-831-9259
Practice Address - Street 1:1137 STATE ROUTE 131
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2715
Practice Address - Country:US
Practice Address - Phone:513-831-8225
Practice Address - Fax:513-831-9259
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist