Provider Demographics
NPI:1053634345
Name:PANNHURST, AMY LAUZON (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LAUZON
Last Name:PANNHURST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1751
Mailing Address - Country:US
Mailing Address - Phone:518-483-9090
Mailing Address - Fax:518-483-9096
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1751
Practice Address - Country:US
Practice Address - Phone:518-483-9090
Practice Address - Fax:518-483-9096
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047460-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist