Provider Demographics
NPI:1225676836
Name:AMOAH, COLLINS
Entity Type:Individual
Prefix:
First Name:COLLINS
Middle Name:
Last Name:AMOAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10549 N FLORIDA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6707
Mailing Address - Country:US
Mailing Address - Phone:571-332-0162
Mailing Address - Fax:
Practice Address - Street 1:10549 N FLORIDA AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6707
Practice Address - Country:US
Practice Address - Phone:813-221-3131
Practice Address - Fax:813-343-4321
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist