Provider Demographics
NPI:1487157061
Name:AMORNYARD, ALEX (RPH)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:AMORNYARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LYNNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-9658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:651 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-9498
Practice Address - Country:US
Practice Address - Phone:740-942-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist