Provider Demographics
NPI:1992410914
Name:AMENDOLARO, CASEY (RPH)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:AMENDOLARO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 KNAVE LN
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-3308
Mailing Address - Country:US
Mailing Address - Phone:954-655-5041
Mailing Address - Fax:
Practice Address - Street 1:3040 VENTURE LN STE 103
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-8173
Practice Address - Country:US
Practice Address - Phone:321-242-2996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT29772183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician