Provider Demographics
NPI:1295337962
Name:FERRIS, AMANDA LEA (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
Last Name:FERRIS
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 1:32228 COTTAGE GLEN LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-5090
Mailing Address - Country:US
Mailing Address - Phone:505-990-9440
Mailing Address - Fax:
Practice Address - Street 1:14323 S US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-2039
Practice Address - Country:US
Practice Address - Phone:813-922-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist