Provider Demographics
NPI:1053029272
Name:AMAYA, ALEXIS LORRAINE (RPH)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LORRAINE
Last Name:AMAYA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4943 AUGUSTA SQ
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5670
Mailing Address - Country:US
Mailing Address - Phone:210-416-1454
Mailing Address - Fax:
Practice Address - Street 1:17238 BULVERDE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-2401
Practice Address - Country:US
Practice Address - Phone:210-642-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist