Provider Demographics
NPI:1679616841
Name:AMELOTTE, RICHARD RENE (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RENE
Last Name:AMELOTTE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WEST MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:HELLAM
Mailing Address - State:PA
Mailing Address - Zip Code:17406
Mailing Address - Country:US
Mailing Address - Phone:717-755-4409
Mailing Address - Fax:717-718-9375
Practice Address - Street 1:72 WEST MARKET STREET
Practice Address - Street 2:
Practice Address - City:HELLAM
Practice Address - State:PA
Practice Address - Zip Code:17406
Practice Address - Country:US
Practice Address - Phone:717-755-4409
Practice Address - Fax:717-718-9375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP026064L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077503Medicare ID - Type Unspecified