Healthcare Provider Details

I. General information

NPI: 1013854488
Provider Name (Legal Business Name): JAYMES HOLLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SW 115TH AVE
DAVIE FL
33325-4706
US

IV. Provider business mailing address

1501 SW 115TH AVE
DAVIE FL
33325-4706
US

V. Phone/Fax

Practice location:
  • Phone: 650-273-2627
  • Fax:
Mailing address:
  • Phone: 650-273-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS19444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: