Healthcare Provider Details

I. General information

NPI: 1205135993
Provider Name (Legal Business Name): IRENE ESQUIVEL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRENE LANIER

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 FIVE FORKS TRICKUM RD
LAWRENCEVILLE GA
30044-5872
US

IV. Provider business mailing address

2990 FIVE FORKS TRICKUM RD
LAWRENCEVILLE GA
30044-5872
US

V. Phone/Fax

Practice location:
  • Phone: 404-966-7700
  • Fax:
Mailing address:
  • Phone: 770-978-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017614
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: