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General NPI Number Information
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NPI Number | 1265617955
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Entity Type | Individual
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Provider Name | AMY BETH FAGAN R.PH., J.D.
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Gender | Female
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Dates
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Enumeration Date | 01/01/2008
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 2324 PINE RIDGE RD
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City | NAPLES
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State | FL
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Zip | 34109-2003
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Country | US
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Telephone | 239-435-0151
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Fax | 239-330-3472
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Provider Business Mailing Address
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Address Line | 2324 PINE RIDGE RD
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City | NAPLES
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State | FL
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Zip | 34109-2003
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Country | US
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Telephone | 239-435-0151
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Fax | 239-330-3472
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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 | 5302027330
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License Number State | MI
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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 | 10957-40
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS46292
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License Number State | FL
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