Provider Demographics
NPI:1124882402
Name:KHATER, AMANDA ROSE (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:KHATER
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8056 DANCING WIND LN APT 1605
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3613
Mailing Address - Country:US
Mailing Address - Phone:713-427-2547
Mailing Address - Fax:
Practice Address - Street 1:6800 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3588
Practice Address - Country:US
Practice Address - Phone:239-417-6647
Practice Address - Fax:239-417-6653
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist