Provider Demographics
NPI:1699049106
Name:RAINS-VINES, AMBER LAUREL (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LAUREL
Last Name:RAINS-VINES
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 1:148 SIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753-1219
Mailing Address - Country:US
Mailing Address - Phone:706-734-3372
Mailing Address - Fax:
Practice Address - Street 1:49 HARRELL ST
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1479
Practice Address - Country:US
Practice Address - Phone:706-734-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18811183500000X
FLPS39308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist