| NPI | 1215221403 |
|---|---|
| Former Name | AMANDA LEIGH DREVYANKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 16163040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 21303) |
| Enumeration Date | 2011-06-05 |
| Last Update Date | 2011-06-05 |