Provider Demographics
NPI:1457521221
Name:BRETON, AMALIA LETICIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMALIA
Middle Name:LETICIA
Last Name:BRETON
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 1:16708 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2876
Mailing Address - Country:US
Mailing Address - Phone:352-474-6101
Mailing Address - Fax:352-474-6091
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:00-P
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-474-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist