Provider Demographics
NPI:1841958329
Name:CASTILLO, AMBER BRYANNE
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:BRYANNE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 ARNOLD CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5903
Mailing Address - Country:US
Mailing Address - Phone:256-648-0142
Mailing Address - Fax:256-760-1780
Practice Address - Street 1:869 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4870
Practice Address - Country:US
Practice Address - Phone:256-764-4700
Practice Address - Fax:256-760-1780
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT49929183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician