Healthcare Provider Details

I. General information

NPI: 1275695900
Provider Name (Legal Business Name): HOLLY KATHRYNE CHITWOOD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTHSIDE FORSYTH DR HOMECARE PHARMACY
CUMMING GA
30041-7659
US

IV. Provider business mailing address

111 WOODSTONE PL
DAWSONVILLE GA
30534-7473
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-3396
  • Fax:
Mailing address:
  • Phone: 706-216-4743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH014138
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: