Provider Demographics
NPI:1083214134
Name:AMOR, YOLANDA
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:AMOR
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 1:10900 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6406
Mailing Address - Country:US
Mailing Address - Phone:772-335-3992
Mailing Address - Fax:772-335-3724
Practice Address - Street 1:10900 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6406
Practice Address - Country:US
Practice Address - Phone:772-335-3992
Practice Address - Fax:772-335-3724
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist