MEDICARE: DR. LISA CAROL HOLLOMAN PHARM.D., BCPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1300X	Psychiatric Pharmacist	496202	CA

General Provider Information

NPI Number	:	1831271964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA CAROL HOLLOMAN PHARM.D., BCPP

Provider Business Mailing Address
First Line	:	9009 LLOYD PL
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-5504
Country	:	US
Telephone Number	:	310-859-1288
Fax Number	:

Provider Business Practice Location Address
First Line	:	11370 WILSHIRE BOULEVARD
Second Line	:	BUILDING 206 ROOM 230
City	:	LOS ANGELES
State	:	CA
Zip	:	90073
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:	310-268-4801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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