Healthcare Provider Details

I. General information

NPI: 1598057366
Provider Name (Legal Business Name): HOLLY G MACINTOSH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY G MASSEY PHARMD

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180-0022
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 637-186-7447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-010418
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: