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General NPI Number Information
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NPI Number | 1790295186
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Entity Type | Individual
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Provider Name | SHAQUITA RENEE AMANQUAH PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 2104 MASSEY AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32228
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Country | US
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Telephone | 904-270-4407
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Fax |
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Provider Business Mailing Address
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Address Line | 4710 SEASCAPE WAY APT 308
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City | JACKSONVILLE
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State | FL
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Zip | 32224-0650
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Country | US
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Telephone | 404-717-3054
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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 | PS56997
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License Number State | FL
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