Healthcare Provider Details

I. General information

NPI: 1265959688
Provider Name (Legal Business Name): AMANDA MARIE HYDOCK PHARM.D., RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RESORT PLAZA DR
BLAIRSVILLE PA
15717-7964
US

IV. Provider business mailing address

100 BRIAR LN
NEW KENSINGTON PA
15068-7138
US

V. Phone/Fax

Practice location:
  • Phone: 724-459-5938
  • Fax:
Mailing address:
  • Phone: 724-420-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP451833
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: