Provider Demographics
NPI:1962002345
Name:DELANA, AMANDA BETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BETH
Last Name:DELANA
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 1:11020 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3002
Mailing Address - Country:US
Mailing Address - Phone:918-209-7016
Mailing Address - Fax:918-209-7015
Practice Address - Street 1:11020 S ELM ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3002
Practice Address - Country:US
Practice Address - Phone:918-209-7016
Practice Address - Fax:918-209-7015
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist