Healthcare Provider Details

I. General information

NPI: 1467334086
Provider Name (Legal Business Name): HOLLY WIDELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

5601 SW 35TH WAY
GAINESVILLE FL
32608-5257
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-4170
  • Fax:
Mailing address:
  • Phone: 813-712-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: