Individual
DR. AMANDA LEE STAAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
325 FERRY ST, NEW HAVEN, CT 06513-3702
(203) 777-0695
Mailing address
325 FERRY ST, NEW HAVEN, CT 06513-3702
(203) 777-0695
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
17721
CO
183500000X
Pharmacist
62743
CA
183500000X
Pharmacist
Primary
PCT.0010533
CT
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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