Provider Demographics
NPI:1184901084
Name:VAUGHAN PEREZ, AMANDA ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:VAUGHAN PEREZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2501 S FRENCH AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5302
Mailing Address - Country:US
Mailing Address - Phone:401-321-0518
Mailing Address - Fax:
Practice Address - Street 1:2501 S FRENCH AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773
Practice Address - Country:US
Practice Address - Phone:407-321-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209780183500000X
FLPS44302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist