MEDICARE: HOLLY SPRINGS PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHRE009819	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2170893	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023382314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLY SPRINGS PHARMACY LLC

Provider Business Mailing Address
First Line	:	3422 SIXES RD STE 106
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-9120
Country	:	US
Telephone Number	:	770-213-3341
Fax Number	:	770-213-3294

Provider Business Practice Location Address
First Line	:	3422 SIXES RD STE 106
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-9120
Country	:	US
Telephone Number	:	770-213-3341
Fax Number	:	770-213-3294

Authorized Official
Title or Position	:	OWNER/RPH/AO
Name	:	JONATHAN MARQUESS
Credential	:	RPH
Telephone Number	:	678-285-0760

Provider Enumeration Date	:	03/04/2012
Last Update Date	:	07/19/2018

Similar Medicare Providers

1174831218 — CANTON PHYSICAL MEDICARE, LLC
Practice Location Address:

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax:

1568839546 — STEPHANIE LURATE DC
Practice Location Address:

3422 SIXES RD STE 110
CANTON, GA
30114-9120

Practice Phone: 770-213-8890
Practice Fax: 470-260-4681

1558092346 — LITTLE RIVER FAMILY CHIROPRACTIC, INC
Practice Location Address:

3422 SIXES RD STE 110
CANTON, GA
30114-9120

Practice Phone: 770-213-8890
Practice Fax:

1356843528 — TENISHA L. MEKO NP-C
Practice Location Address:

3422 SIXES RD STE 102
CANTON, GA
30114-9120

Practice Phone: 943-202-7670
Practice Fax: 470-986-7143

1396580643 — MISS KAYLA JUSTINE STAFFORD FNP-C
Practice Location Address:

3422 SIXES RD STE 102
CANTON, GA
30114-9120

Practice Phone: 943-202-7670
Practice Fax:

1871389650 — BACK 2 BACK CHIROPRACTIC CANTON LLC
Practice Location Address:

3422 SIXES RD STE 110
CANTON, GA
30114-9120

Practice Phone: 715-862-2423
Practice Fax:

Directions to “HOLLY SPRINGS PHARMACY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.