Provider Demographics
NPI:1649383217
Name:RODRIGUEZ, AMANDA CRYSTAL MILLS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CRYSTAL MILLS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:CRYSTAL
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:10300 DOVE CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:NEWALLA
Mailing Address - State:OK
Mailing Address - Zip Code:74857
Mailing Address - Country:US
Mailing Address - Phone:405-818-6036
Mailing Address - Fax:
Practice Address - Street 1:14890 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020
Practice Address - Country:US
Practice Address - Phone:405-390-3205
Practice Address - Fax:405-737-9554
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist