Provider Demographics
NPI:1093073389
Name:AMONETT, HOLLY E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:E
Last Name:AMONETT
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 1:3608 S LAFOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3809
Mailing Address - Country:US
Mailing Address - Phone:765-455-2191
Mailing Address - Fax:765-455-2240
Practice Address - Street 1:9390 FORD AVE STE 16
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6419
Practice Address - Country:US
Practice Address - Phone:912-459-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist