Healthcare Provider Details

I. General information

NPI: 1568909679
Provider Name (Legal Business Name): AMHERST PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MONTAGUE RD
AMHERST MA
01002-1027
US

IV. Provider business mailing address

381 COLLEGE ST
AMHERST MA
01002-2391
US

V. Phone/Fax

Practice location:
  • Phone: 413-992-2145
  • Fax: 413-992-2143
Mailing address:
  • Phone: 413-253-0387
  • Fax: 413-253-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberDS90076
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: IOANNIS NIKITAS
Title or Position: PHARMACIST
Credential:
Phone: 413-256-1716