Healthcare Provider Details

I. General information

NPI: 1508347881
Provider Name (Legal Business Name): AMIE DANIELLE MIZELL PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 NW 43RD ST STE 401
GAINESVILLE FL
32606-4483
US

IV. Provider business mailing address

3936 NW 34TH PL
GAINESVILLE FL
32606-6154
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-0585
  • Fax:
Mailing address:
  • Phone: 352-213-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS58243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: