Provider Demographics
NPI:1770703233
Name:AMENTA, RICHARD E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:AMENTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 MASON DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1964
Mailing Address - Country:US
Mailing Address - Phone:586-997-2050
Mailing Address - Fax:586-997-2053
Practice Address - Street 1:13500 22 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-4294
Practice Address - Country:US
Practice Address - Phone:586-997-2050
Practice Address - Fax:586-997-2053
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist