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General NPI Number Information
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NPI Number | 1508323999
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Entity Type | Individual
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Provider Name | AMANDA A ABRAHAM RPH
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Gender | Female
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 940 S QUAKER LN
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1458
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Country | US
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Telephone | 860-231-7665
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Fax |
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Provider Business Mailing Address
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Address Line | 241 KINNE RD
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City | GLASTONBURY
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State | CT
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Zip | 06033-3853
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Country | US
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Telephone | 203-893-5747
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0014640
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License Number State | CT
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