Provider Demographics
NPI:1962859413
Name:AMEDEE, ELLIOTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:
Last Name:AMEDEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11080 GREENWELL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-7001
Mailing Address - Country:US
Mailing Address - Phone:225-273-6525
Mailing Address - Fax:
Practice Address - Street 1:11080 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-7001
Practice Address - Country:US
Practice Address - Phone:225-273-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist