Provider Demographics
NPI:1801099437
Name:JERAULD, AMBER L (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:JERAULD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:L
Other - Last Name:CRONK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4417 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3556
Mailing Address - Country:US
Mailing Address - Phone:607-770-7365
Mailing Address - Fax:607-240-2984
Practice Address - Street 1:4417 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3556
Practice Address - Country:US
Practice Address - Phone:607-770-7365
Practice Address - Fax:607-240-2984
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4404321835P1200X
NY0615011835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy