Healthcare Provider Details

I. General information

NPI: 1023391711
Provider Name (Legal Business Name): AMY LYNNE EMERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 PLYMOUTH AVE
FALL RIVER MA
02721-4215
US

IV. Provider business mailing address

33 ARBOR DR
COVENTRY RI
02816
US

V. Phone/Fax

Practice location:
  • Phone: 508-730-2902
  • Fax:
Mailing address:
  • Phone: 401-864-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH233444
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04986
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: