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Individual

AMY LARISSA DEDEA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHARMD, PA-C

Contact information

Practice address
12075 AZ-69, DEWEY, AZ 86327
(928) 772-1673
Mailing address
85 CANYON TRL, SEDONA, AZ 86351-7705
(928) 773-2525

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
PS38830
FL
183500000X
Pharmacist
S018219
AZ
363A00000X
Physician Assistant
Primary
2405
CT

Other

Enumeration date
08/19/2006
Last updated
09/18/2019
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