Provider Demographics
NPI:1669368270
Name:HORKOSS, AMANIE
Entity type:Individual
Prefix:
First Name:AMANIE
Middle Name:
Last Name:HORKOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 S SARE RD APT 404
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4388
Mailing Address - Country:US
Mailing Address - Phone:765-823-1142
Mailing Address - Fax:
Practice Address - Street 1:1206 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3707
Practice Address - Country:US
Practice Address - Phone:812-275-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26031272A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist