Healthcare Provider Details

I. General information

NPI: 1093073389
Provider Name (Legal Business Name): HOLLY E AMONETT PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9390 FORD AVE STE 16
RICHMOND HILL GA
31324-6419
US

IV. Provider business mailing address

3608 S LAFOUNTAIN ST
KOKOMO IN
46902-3809
US

V. Phone/Fax

Practice location:
  • Phone: 912-459-4400
  • Fax:
Mailing address:
  • Phone: 765-455-2191
  • Fax: 765-455-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025700
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: