Provider Demographics
NPI:1801128038
Name:HOLLINGSWORTH, SANDRA SUE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SUE
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 MARIETTA HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8387
Mailing Address - Country:US
Mailing Address - Phone:770-479-8771
Mailing Address - Fax:
Practice Address - Street 1:1750 MARIETTA HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8387
Practice Address - Country:US
Practice Address - Phone:770-479-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist