| NPI | 1891195137 |
|---|---|
| Former Name | AMANDA SUE RABIDEAU |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P7083) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID CS36244) |
| 183500000X Pharmacist (Licence: NY I059211-1) | |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2014-08-22 |