Individual
AMANDA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1407 LINCOLNWAY, LA PORTE, IN 46350-3105
(219) 362-3446
Mailing address
1407 LINCOLNWAY, LA PORTE, IN 46350-3105
(219) 362-3446
(219) 362-4228
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26022132A
IN
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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