Provider Demographics
NPI:1932571312
Name:PENDER, HOLLI E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HOLLI
Middle Name:E
Last Name:PENDER
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 1:123 BEALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:GA
Mailing Address - Zip Code:30814-4944
Mailing Address - Country:US
Mailing Address - Phone:803-645-3969
Mailing Address - Fax:
Practice Address - Street 1:100 MYRTLE BLVD.
Practice Address - Street 2:
Practice Address - City:GRACEWOOD
Practice Address - State:GA
Practice Address - Zip Code:30812
Practice Address - Country:US
Practice Address - Phone:706-790-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028202183500000X, 283Q00000X
SC35562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No283Q00000XHospitalsPsychiatric Hospital