Healthcare Provider Details

I. General information

NPI: 1457326720
Provider Name (Legal Business Name): HARRY LLOYD HOLSTON JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13286 N WINTZELL AVE
BAYOU LA BATRE AL
36509-2146
US

IV. Provider business mailing address

8708 COLEMAN HOMESTEAD RD
MOSS POINT MS
39562-9375
US

V. Phone/Fax

Practice location:
  • Phone: 251-824-7455
  • Fax: 251-824-7450
Mailing address:
  • Phone: 228-588-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10991
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: