Provider Demographics
NPI:1801028535
Name:LOCKWOOD, AMY MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:RUTHVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:226 LAKE STREET PLZ
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1811
Mailing Address - Country:US
Mailing Address - Phone:315-536-3811
Mailing Address - Fax:
Practice Address - Street 1:226 LAKE STREET PLZ
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1811
Practice Address - Country:US
Practice Address - Phone:315-536-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI053217183500000X
NY053217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist