Healthcare Provider Details

I. General information

NPI: 1609111491
Provider Name (Legal Business Name): AMBER MICHELE SHANKLAND PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3612
US

IV. Provider business mailing address

2543 ANNAPOLIS WAY #211
BRANDON FL
33511-2341
US

V. Phone/Fax

Practice location:
  • Phone: 813-387-1162
  • Fax:
Mailing address:
  • Phone: 941-323-0615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: