Provider Demographics
NPI:1902629256
Name:WIREMAN, AMBER NICOLE (RPH)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:WIREMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7735 PURITY RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43071-9702
Mailing Address - Country:US
Mailing Address - Phone:740-588-3267
Mailing Address - Fax:
Practice Address - Street 1:2850 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1723
Practice Address - Country:US
Practice Address - Phone:740-455-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist