Active NPI
Amanda Dacey Memoli, PHARMD
- Pharmacist
- Baltimore, MD
National Provider Identifier
1629594403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20176
- Practice address
- 3779 Boston St
Baltimore, MD 21224-5752 - Phone
- (410) 522-0804
- Fax
- (410) 522-5613
- NPI assigned
- Aug 14, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20176 | MD | Primary |
Addresses
Primary practice location
3779 Boston St
Baltimore, MD 21224-5752
Mailing address
16 Crestmont Dr
Aberdeen, MD 21001-2401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20176 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502668800000",
"number": "1629594403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 CRESTMONT DR",
"city": "ABERDEEN",
"state": "MD",
"postal_code": "210012401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3779 BOSTON ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212245752",
"telephone_number": "410-522-0804",
"fax_number": "410-522-5613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEMOLI",
"first_name": "AMANDA",
"middle_name": "DACEY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-14",
"last_updated": "2017-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "20176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.