Provider Demographics
NPI:1396507935
Name:AMADASUN, DEXTER (PHARM D)
Entity type:Individual
Prefix:
First Name:DEXTER
Middle Name:
Last Name:AMADASUN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 WESTFIELD ST APT 11
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3827
Mailing Address - Country:US
Mailing Address - Phone:860-922-1953
Mailing Address - Fax:
Practice Address - Street 1:672 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-5069
Practice Address - Country:US
Practice Address - Phone:413-593-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH997171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist