Provider Demographics
NPI:1831413046
Name:RANSOM, AMANDA LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:RANSOM
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 1:109 W MAIN ST
Mailing Address - Street 2:P.O. BOX 895
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622-9553
Mailing Address - Country:US
Mailing Address - Phone:989-588-2900
Mailing Address - Fax:989-588-2901
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MI
Practice Address - Zip Code:48622-9553
Practice Address - Country:US
Practice Address - Phone:989-588-2900
Practice Address - Fax:989-588-2901
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2011-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist