| NPI | 1801119557 |
|---|---|
| Former Name | AMANDA ROCHELLE TEVLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302033724) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03139500) |
| Enumeration Date | 2010-03-09 |
| Last Update Date | 2011-09-08 |