Provider Demographics
NPI:1811591316
Name:AMAEZ, JELITZA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JELITZA
Middle Name:
Last Name:AMAEZ
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 1:1205 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4046
Mailing Address - Country:US
Mailing Address - Phone:407-847-5174
Mailing Address - Fax:407-847-3734
Practice Address - Street 1:1205 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4046
Practice Address - Country:US
Practice Address - Phone:407-847-5174
Practice Address - Fax:407-847-3734
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5269183500000X
FLPS51652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist