Healthcare Provider Details

I. General information

NPI: 1619979242
Provider Name (Legal Business Name): MARY ELLEN HOLLIS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3599 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-9404
US

IV. Provider business mailing address

2013 NW 4TH AVE
DELRAY BEACH FL
33444-3114
US

V. Phone/Fax

Practice location:
  • Phone: 954-333-5215
  • Fax: 954-333-5225
Mailing address:
  • Phone: 561-265-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS19731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: