Amanda Lee Staak, PHARM D

Primary specialty

PharmacistTaxonomy code 183500000X

License

PCT.0010533 Issued in CT

Practice address

325 Ferry St
New Haven, CT 06513-3702

Phone

(203) 777-0695

NPI assigned

Aug 31, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rite Aid of Connecticut Inc

  • Community/Retail Pharmacy
  • New Haven, CT
  • NPI 1326411570
  NPD (past)
• Rite Aid of Connecticut Inc

  • Community/Retail Pharmacy
  • New Haven, CT
  • NPI 1649389024
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283212800000",
    "number": "1013223841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 FERRY ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133702",
            "telephone_number": "203-777-0695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 FERRY ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133702",
            "telephone_number": "203-777-0695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAAK",
        "first_name": "AMANDA",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-31",
        "last_updated": "2010-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "PCT.0010533",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "62743",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "17721",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan St. Jacques, PA-C
• Brad St. Martin, MD
• St. Raphael Dialysis Center Partnership
• St. Raphael Dialysis Center Partnership
• Tayisha Rebecca St. Vil, WHNP-BC
• Jennifer Lyn Stabile, APRN
• Andrew David Stack, O.D.
• Gary E Stack, MD
• Stages of Change Counseling
• Mary-Ann Alisha Staggers, LCSW

• Pharmacist in New Haven, CT
• Providers in New Haven, CT by specialty
• Pharmacist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.