Provider Demographics
NPI:1962749036
Name:FLEENOR, AMANDA ANGEL (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANGEL
Last Name:FLEENOR
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 1:5055 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8719
Mailing Address - Country:US
Mailing Address - Phone:850-484-9978
Mailing Address - Fax:850-473-6824
Practice Address - Street 1:5055 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8719
Practice Address - Country:US
Practice Address - Phone:850-484-9978
Practice Address - Fax:850-473-6824
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38951183500000X
AL15192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist