Provider Demographics
NPI:1235675208
Name:BIRES, AMANDA DENISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DENISE
Last Name:BIRES
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 1:488 CARROLLTON ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:GA
Mailing Address - Zip Code:30179-4144
Mailing Address - Country:US
Mailing Address - Phone:770-562-2716
Mailing Address - Fax:770-562-2778
Practice Address - Street 1:488 CARROLLTON ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:GA
Practice Address - Zip Code:30179-4144
Practice Address - Country:US
Practice Address - Phone:770-562-2716
Practice Address - Fax:770-562-2778
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist