Provider Demographics
NPI:1467163402
Name:DE LA CRUZ, AMANDA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:DE LA CRUZ
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 1:3287 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4501
Mailing Address - Country:US
Mailing Address - Phone:281-485-7843
Mailing Address - Fax:
Practice Address - Street 1:3287 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4501
Practice Address - Country:US
Practice Address - Phone:281-485-7843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist