MEDICARE: DR. AMANDA BERCEY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	019517	LA

General Provider Information

NPI Number	:	1962783787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA BERCEY PHARMD

Provider Business Mailing Address
First Line	:	238 N SAND PALM RD FL 32439
Second Line	:
City	:	FREEPORT
State	:	FL
Zip	:	32439-3731
Country	:	US
Telephone Number	:	504-330-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 W COUNTY HIGHWAY 30A # M1-106
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-0187
Country	:	US
Telephone Number	:	850-622-3313
Fax Number	:	850-622-3255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	11/28/2022

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