Individual
DR. AMANDA ROSE PHOENIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D., BCACP, CDE
Contact information
Practice address
1650 GRAND CONCOURSE, BRONX, NY 10457-7606
(631) 835-3111
Mailing address
56 BROOK MANOR LN, PLEASANTVILLE, NY 10570-2416
(631) 835-3311
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
061184
NY
1835P1200X
Pharmacotherapy Pharmacist
Primary
061184
NY
1835P2201X
Ambulatory Care Pharmacist
061184
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05752314
—
NY
05
—
05752534
—
NY
Enumeration date
09/16/2016
Last updated
11/21/2020
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