Provider Demographics
NPI:1710071212
Name:BAIN, AMY MARIE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE
Last Name:BAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8725 SOUTHWESTERN BLVD
Mailing Address - Street 2:APT. #1334
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-8287
Mailing Address - Country:US
Mailing Address - Phone:843-991-0928
Mailing Address - Fax:214-302-1403
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:R119B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:214-302-1403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC114811835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy