1245710318 NPI number — DR. AMANDA LEIGH PATSFIELD PHARMD

Table of content: (NPI 1073733812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245710318 NPI number — DR. AMANDA LEIGH PATSFIELD PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATSFIELD
Provider First Name:
AMANDA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATSFIELD
Provider Other First Name:
AMANDA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245710318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2606 GREENUP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40217-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-767-3721
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 PATROL RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47111-8670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-850-7207
Provider Business Practice Location Address Fax Number:
812-256-7339
Provider Enumeration Date:
08/18/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  013704 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26028059A . This is a "REGISTERED PHARMACIST" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 013704 . This is a "REGISTERED PHARMACIST" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".