Provider Demographics
NPI:1174807820
Name:BALCERZAK, AMANDA C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:C
Last Name:BALCERZAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3340 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2008
Mailing Address - Country:US
Mailing Address - Phone:205-664-8027
Mailing Address - Fax:205-664-8312
Practice Address - Street 1:3340 PELHAM PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2008
Practice Address - Country:US
Practice Address - Phone:205-664-8027
Practice Address - Fax:205-664-8312
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16152183500000X
KY014465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist