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General NPI Number Information
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NPI Number | 1467924977
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Entity Type | Individual
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Provider Name | AMANDA SUE BOLTON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 3001 JOE RAMSEY BLVD E
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City | GREENVILLE
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State | TX
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Zip | 75401-7714
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Country | US
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Telephone | 903-455-7200
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Fax | 903-455-7300
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Provider Business Mailing Address
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Address Line | 4451 COUNTY ROAD 4410
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City | COMMERCE
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State | TX
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Zip | 75428-6821
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Country | US
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Telephone | 720-375-4268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 62190
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License Number State | TX
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