Provider Demographics
NPI:1366030603
Name:HOLLIS, NEAL
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 KING GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9569
Mailing Address - Country:US
Mailing Address - Phone:912-920-1500
Mailing Address - Fax:912-920-6967
Practice Address - Street 1:1080 KING GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9569
Practice Address - Country:US
Practice Address - Phone:912-920-1500
Practice Address - Fax:912-920-6967
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist