Healthcare Provider Details

I. General information

NPI: 1568289445
Provider Name (Legal Business Name): HOLLY WHITNEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MASSACHUSETTS ST
LAWRENCE KS
66046-4808
US

IV. Provider business mailing address

2415 MASSACHUSETTS ST
LAWRENCE KS
66046-4827
US

V. Phone/Fax

Practice location:
  • Phone: 785-843-3750
  • Fax: 785-832-4878
Mailing address:
  • Phone: 785-843-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16834
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: