Provider Demographics
NPI:1871929422
Name:ZELL, AMANDA ELYSE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELYSE
Last Name:ZELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11604 S ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 TURNER MCCALL BLVD NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2735
Practice Address - Country:US
Practice Address - Phone:706-291-3385
Practice Address - Fax:706-622-5906
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist