Provider Demographics
NPI:1922778026
Name:LIEDKE, PAMELA E (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:E
Last Name:LIEDKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16008 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:REDINGTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1637
Mailing Address - Country:US
Mailing Address - Phone:727-215-9071
Mailing Address - Fax:
Practice Address - Street 1:16008 4TH ST E
Practice Address - Street 2:
Practice Address - City:REDINGTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-1637
Practice Address - Country:US
Practice Address - Phone:727-215-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS14390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist