Healthcare Provider Details

I. General information

NPI: 1437788288
Provider Name (Legal Business Name): AMANDA LARSH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA HARMAN

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 ST VINCENTS WAY
MIDDLEBURG FL
32068-8447
US

IV. Provider business mailing address

2884 WOODBRIDGE CROSSING CT
GREEN COVE SPRINGS FL
32043-7048
US

V. Phone/Fax

Practice location:
  • Phone: 904-602-1000
  • Fax:
Mailing address:
  • Phone: 850-449-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19984
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: