Provider Demographics
NPI:1801605597
Name:LOVE, AMIANA ROSE
Entity type:Individual
Prefix:
First Name:AMIANA
Middle Name:ROSE
Last Name:LOVE
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 1:3502 PALMER HWY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-6514
Mailing Address - Country:US
Mailing Address - Phone:409-934-4249
Mailing Address - Fax:866-569-0652
Practice Address - Street 1:3502 PALMER HWY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-6514
Practice Address - Country:US
Practice Address - Phone:409-934-4249
Practice Address - Fax:866-569-0652
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335885183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician