Provider Demographics
NPI:1104342831
Name:CABANISS, AMBER ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ELIZABETH
Last Name:CABANISS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 KIMO PL
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-4175
Mailing Address - Country:US
Mailing Address - Phone:228-344-5184
Mailing Address - Fax:
Practice Address - Street 1:348 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2672
Practice Address - Country:US
Practice Address - Phone:228-467-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist