Provider Demographics
NPI:1649062258
Name:GUZMAN, AMELY YEILIZ
Entity type:Individual
Prefix:
First Name:AMELY
Middle Name:YEILIZ
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 STONE BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-9505
Mailing Address - Country:US
Mailing Address - Phone:228-229-9489
Mailing Address - Fax:
Practice Address - Street 1:7021 HIGHWAY 614
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:MS
Practice Address - Zip Code:39555
Practice Address - Country:US
Practice Address - Phone:228-588-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE-101852OtherMISSISSIPPI BOARD OF PHARMACY