Provider Demographics
NPI:1750419214
Name:DIZOL, AMY L (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:DIZOL
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 1:3730 HENRICKS HILL DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6181
Mailing Address - Country:US
Mailing Address - Phone:615-220-6345
Mailing Address - Fax:
Practice Address - Street 1:3026 OWEN DR
Practice Address - Street 2:SUITE 116
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2417
Practice Address - Country:US
Practice Address - Phone:615-641-3845
Practice Address - Fax:615-641-3846
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21868183500000X
AL14948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist