Provider Demographics
NPI:1548936552
Name:ATALLA, AMANY EDSON (PHARMD)
Entity type:Individual
Prefix:
First Name:AMANY
Middle Name:EDSON
Last Name:ATALLA
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 1:10460 TRIANON PL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8074
Mailing Address - Country:US
Mailing Address - Phone:561-312-2848
Mailing Address - Fax:
Practice Address - Street 1:127 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33414-4338
Practice Address - Country:US
Practice Address - Phone:561-615-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist