Healthcare Provider Details

I. General information

NPI: 1639667678
Provider Name (Legal Business Name): KAREN D HOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MCINGVALE RD
HERNANDO MS
38632-8658
US

IV. Provider business mailing address

1110 MIDDLE BUSTER RD
HERNANDO MS
38632-7755
US

V. Phone/Fax

Practice location:
  • Phone: 662-429-8767
  • Fax: 662-429-8599
Mailing address:
  • Phone: 901-494-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT7871
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: