Provider Demographics
NPI:1205105574
Name:ASHCRAFT, AMYANNE KAY (RPH)
Entity type:Individual
Prefix:DR
First Name:AMYANNE
Middle Name:KAY
Last Name:ASHCRAFT
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 1:2413 COOKE DR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-2130
Mailing Address - Country:US
Mailing Address - Phone:352-396-2076
Mailing Address - Fax:352-323-3383
Practice Address - Street 1:2413 COOKE DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-2130
Practice Address - Country:US
Practice Address - Phone:352-396-2076
Practice Address - Fax:352-323-3383
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist