Provider Demographics
NPI:1316206683
Name:MAZUR, AMANDA MARGARET (RPH, C PH)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARGARET
Last Name:MAZUR
Suffix:
Gender:F
Credentials:RPH, C PH
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MARGARET
Other - Last Name:GLOSSIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1140 E VAN FLEET DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-7626
Mailing Address - Country:US
Mailing Address - Phone:863-537-6910
Mailing Address - Fax:863-537-7302
Practice Address - Street 1:HIYARX, LLC
Practice Address - Street 2:DBA QUICKRX@BARTOW
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3383
Practice Address - Country:US
Practice Address - Phone:863-537-6910
Practice Address - Fax:863-537-7302
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 27329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist