Provider Demographics
NPI:1457647372
Name:SOZA, AMANDA LEONOR (PHARM D)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEONOR
Last Name:SOZA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2409
Mailing Address - Country:US
Mailing Address - Phone:985-857-8620
Mailing Address - Fax:
Practice Address - Street 1:1727 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2409
Practice Address - Country:US
Practice Address - Phone:985-857-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49152183500000X
LA019394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist