Provider Demographics
NPI:1689958274
Name:PATEL, AMANDA JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:PATEL
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 1:2401 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2301
Mailing Address - Country:US
Mailing Address - Phone:314-963-1925
Mailing Address - Fax:
Practice Address - Street 1:2401 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2301
Practice Address - Country:US
Practice Address - Phone:314-963-1925
Practice Address - Fax:636-532-1298
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009020941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist