| Organization Name: | AMALIE GROUP LLC |
| NPI Number: | 1205129178 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETER X KONICKI (PRESIDENT) |
| Mailing Address: | 230 W Tioga St Suite 3 Tunkhannock |
| State: | PA US |
| Postal Code: | 186576667 |
| Phone Number: | 5709960440 |
| Fax Number: | 5709960217 |
| NPI Enumeration Date: | 05/25/2011 |
| NPI Last Update Date: | 05/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | PP482108 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |