Provider Demographics
NPI:1194010074
Name:LONDEREE, AMANDA BETH (RPH)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BETH
Last Name:LONDEREE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PALMETTO CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3536
Mailing Address - Country:US
Mailing Address - Phone:407-353-1384
Mailing Address - Fax:
Practice Address - Street 1:886 W STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3006
Practice Address - Country:US
Practice Address - Phone:407-618-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0022145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist