Healthcare Provider Details

I. General information

NPI: 1548860885
Provider Name (Legal Business Name): AMY C RASE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 GALLIA ST
NEW BOSTON OH
45662-5553
US

IV. Provider business mailing address

4490 GALLIA ST
NEW BOSTON OH
45662-5553
US

V. Phone/Fax

Practice location:
  • Phone: 740-456-8267
  • Fax: 740-456-6156
Mailing address:
  • Phone: 740-456-8267
  • Fax: 740-456-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03223662
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: