Provider Demographics
NPI:1669082343
Name:SUTTON KICKLIGHTER, AMANI MACHEL (PHARMD, BCPS, BC-ADM)
Entity type:Individual
Prefix:
First Name:AMANI
Middle Name:MACHEL
Last Name:SUTTON KICKLIGHTER
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 MIDHURST DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1462
Mailing Address - Country:US
Mailing Address - Phone:704-995-7789
Mailing Address - Fax:
Practice Address - Street 1:250 JOSEPHS DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3405
Practice Address - Country:US
Practice Address - Phone:757-272-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29791183500000X
VA0202220602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist