Provider Demographics
NPI:1912593476
Name:LOMBARDO, AMY E
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:LOMBARDO
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 1:377 CHAUNCY ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1169
Mailing Address - Country:US
Mailing Address - Phone:508-337-9455
Mailing Address - Fax:
Practice Address - Street 1:377 CHAUNCY ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1169
Practice Address - Country:US
Practice Address - Phone:508-337-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist