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General NPI Number Information
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NPI Number | 1184901084
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Entity Type | Individual
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Provider Name | AMANDA ELIZABETH VAUGHAN PEREZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 2501 S FRENCH AVE
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City | SANFORD
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State | FL
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Zip | 32773
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Country | US
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Telephone | 407-321-0518
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 S FRENCH AVE
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City | SANFORD
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State | FL
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Zip | 32773-5302
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Country | US
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Telephone | 401-321-0518
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202209780
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS44302
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License Number State | FL
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