Provider Demographics
NPI:1902586860
Name:MCKANE, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MCKANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2631
Mailing Address - Country:US
Mailing Address - Phone:440-593-6258
Mailing Address - Fax:
Practice Address - Street 1:364 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2631
Practice Address - Country:US
Practice Address - Phone:440-593-6258
Practice Address - Fax:440-593-6896
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443282183500000X
PARP457702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist