Healthcare Provider Details

I. General information

NPI: 1679616841
Provider Name (Legal Business Name): RICHARD RENE AMELOTTE PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 WEST MARKET STREET
HELLAM PA
17406
US

IV. Provider business mailing address

72 WEST MARKET STREET
HELLAM PA
17406
US

V. Phone/Fax

Practice location:
  • Phone: 717-755-4409
  • Fax: 717-718-9375
Mailing address:
  • Phone: 717-755-4409
  • Fax: 717-718-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP026064L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: