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General NPI Number Information
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NPI Number | 1629594403
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Entity Type | Individual
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Provider Name | AMANDA DACEY MEMOLI PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 08/14/2017
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Provider Practice Location Address
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Address Line | 3779 BOSTON ST
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City | BALTIMORE
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State | MD
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Zip | 21224-5752
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Country | US
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Telephone | 410-522-0804
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Fax | 410-522-5613
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Provider Business Mailing Address
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Address Line | 16 CRESTMONT DR
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City | ABERDEEN
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State | MD
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Zip | 21001-2401
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Country | US
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Telephone |
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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 | 20176
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License Number State | MD
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