Provider Demographics
NPI:1215283759
Name:REED, AMANDA RENEE (RPH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:REED
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 1:4551 ERIE AVE N
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8598
Mailing Address - Country:US
Mailing Address - Phone:330-284-5261
Mailing Address - Fax:
Practice Address - Street 1:242 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-6566
Practice Address - Country:US
Practice Address - Phone:220-832-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03131759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist