Provider Demographics
NPI:1700995701
Name:AMIGO, ANTONIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:AMIGO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5491 W 8TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2408
Mailing Address - Country:US
Mailing Address - Phone:305-325-4455
Mailing Address - Fax:
Practice Address - Street 1:1201 N.W. 16 TH AVENUE
Practice Address - Street 2:VA MEDICAL CENTER - 119 - PHARMACY SERVICE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-325-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 15030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist