Provider Demographics
NPI:1255098760
Name:AMOR, IMENE (PHARMD)
Entity type:Individual
Prefix:
First Name:IMENE
Middle Name:
Last Name:AMOR
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 1:1328 FORREST LANE CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4277
Mailing Address - Country:US
Mailing Address - Phone:314-817-8103
Mailing Address - Fax:
Practice Address - Street 1:1 ROYAL HEIGHTS CTR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5705
Practice Address - Country:US
Practice Address - Phone:618-233-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021015001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist