Provider Demographics
NPI:1376888073
Name:MILMO, AMANDA FAYE (CPHT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:FAYE
Last Name:MILMO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 BITTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3555
Mailing Address - Country:US
Mailing Address - Phone:830-391-7243
Mailing Address - Fax:
Practice Address - Street 1:2929 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3312
Practice Address - Country:US
Practice Address - Phone:210-491-9976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100283183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician