Provider Demographics
NPI:1275145963
Name:KOLARI, AMY JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:KOLARI
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 1:176 PARKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1624
Mailing Address - Country:US
Mailing Address - Phone:218-248-0837
Mailing Address - Fax:
Practice Address - Street 1:875 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2915
Practice Address - Country:US
Practice Address - Phone:641-424-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43663183500000X
IA23820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist