Provider Demographics
NPI:1790295186
Name:AMANQUAH, SHAQUITA RENEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAQUITA
Middle Name:RENEE
Last Name:AMANQUAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SHAQUITA
Other - Middle Name:RENEE
Other - Last Name:MICKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4710 SEASCAPE WAY APT 308
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0650
Mailing Address - Country:US
Mailing Address - Phone:404-717-3054
Mailing Address - Fax:
Practice Address - Street 1:2104 MASSEY AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist