Provider Demographics
NPI:1205135993
Name:ESQUIVEL, IRENE (PHARMD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ESQUIVEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2990 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5872
Mailing Address - Country:US
Mailing Address - Phone:770-978-6475
Mailing Address - Fax:
Practice Address - Street 1:2990 FIVE FORKS TRICKUM RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5872
Practice Address - Country:US
Practice Address - Phone:404-966-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist