Healthcare Provider Details

I. General information

NPI: 1487953816
Provider Name (Legal Business Name): JERRY T HOLLAND JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 YELLOWSTONE AVE
POCATELLO ID
83201-4433
US

IV. Provider business mailing address

800 YELLOWSTONE AVE
POCATELLO ID
83201-4433
US

V. Phone/Fax

Practice location:
  • Phone: 208-239-4033
  • Fax: 208-239-4027
Mailing address:
  • Phone: 208-239-4033
  • Fax: 208-239-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP5677
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5677
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: