Provider Demographics
NPI:1740529684
Name:GREEN, AMANDA L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROBERT PITT DR STE 101P
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3366
Mailing Address - Country:US
Mailing Address - Phone:845-364-4147
Mailing Address - Fax:845-330-2903
Practice Address - Street 1:25 ROBERT PITT DR STE 101P
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3366
Practice Address - Country:US
Practice Address - Phone:845-364-4147
Practice Address - Fax:845-330-2903
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441346183500000X
NYI-069220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist