MEDICARE: CASEY AMENDOLARO RPH

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	183700000X	Pharmacy Technician	RPT29772	FL

General Provider Information

NPI Number	:	1992410914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY AMENDOLARO RPH

Provider Business Mailing Address
First Line	:	1402 KNAVE LN
Second Line	:
City	:	MALABAR
State	:	FL
Zip	:	32950-3308
Country	:	US
Telephone Number	:	954-655-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 VENTURE LN STE 103
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32934-8173
Country	:	US
Telephone Number	:	321-242-2996
Fax Number	:

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

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	01/16/2023

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