Provider Demographics
NPI:1780966259
Name:CROWE, AMANDA J (RPH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:CROWE
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 1:1556 LAWRENCEVILLE HWY
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044
Mailing Address - Country:US
Mailing Address - Phone:770-962-4946
Mailing Address - Fax:
Practice Address - Street 1:1556 LAWRENCEVILLE HWY
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044
Practice Address - Country:US
Practice Address - Phone:770-962-4946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019352183500000X
FLPS27029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist