Provider Demographics
NPI:1265617955
Name:FAGAN, AMY BETH (RPH, JD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH
Last Name:FAGAN
Suffix:
Gender:F
Credentials:RPH, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2003
Mailing Address - Country:US
Mailing Address - Phone:239-435-0151
Mailing Address - Fax:239-330-3472
Practice Address - Street 1:2324 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2003
Practice Address - Country:US
Practice Address - Phone:239-435-0151
Practice Address - Fax:239-330-3472
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027330183500000X
WI10957-40183500000X
FLPS46292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist