Provider Demographics
NPI:1992401590
Name:NEARY, AMANDA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:NEARY
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 1:13414 BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-3413
Mailing Address - Country:US
Mailing Address - Phone:586-747-5826
Mailing Address - Fax:
Practice Address - Street 1:13042 FAIRLANE ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1326
Practice Address - Country:US
Practice Address - Phone:734-762-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315213106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist