Provider Demographics
NPI:1508347881
Name:MIZELL, AMIE DANIELLE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:DANIELLE
Last Name:MIZELL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 NW 34TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6154
Mailing Address - Country:US
Mailing Address - Phone:352-213-0000
Mailing Address - Fax:
Practice Address - Street 1:5200 NW 43RD ST STE 401
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4483
Practice Address - Country:US
Practice Address - Phone:352-376-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS58243OtherSTATE LICENSE