Provider Demographics
NPI:1437771466
Name:HADDAD, AMANDA MUNTASER (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MUNTASER
Last Name:HADDAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 SW 110TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-4247
Mailing Address - Country:US
Mailing Address - Phone:352-857-0158
Mailing Address - Fax:
Practice Address - Street 1:4150 SW 110TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-4247
Practice Address - Country:US
Practice Address - Phone:352-857-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist