Provider Demographics
NPI:1467924977
Name:BOLTON, AMANDA SUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:BOLTON
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 1:4451 COUNTY ROAD 4410
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-6821
Mailing Address - Country:US
Mailing Address - Phone:720-375-4268
Mailing Address - Fax:
Practice Address - Street 1:3001 JOE RAMSEY BLVD E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7714
Practice Address - Country:US
Practice Address - Phone:903-455-7200
Practice Address - Fax:903-455-7300
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist