Healthcare Provider Details

I. General information

NPI: 1972412237
Provider Name (Legal Business Name): VICTORIA ROCHELLE HOLLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 CLOVERDALE AVE
WINSTON SALEM NC
27103-2506
US

IV. Provider business mailing address

2125 CLOVERDALE AVE
WINSTON SALEM NC
27103-2506
US

V. Phone/Fax

Practice location:
  • Phone: 336-723-0561
  • Fax: 336-723-0882
Mailing address:
  • Phone: 336-723-0561
  • Fax: 336-723-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35006
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: