Healthcare Provider Details

I. General information

NPI: 1972579811
Provider Name (Legal Business Name): HOLLADAY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 LANDMARK DR
WINSTON-SALEM NC
27103-6716
US

IV. Provider business mailing address

2560 LANDMARK DR
WINSTON-SALEM NC
27103-6716
US

V. Phone/Fax

Practice location:
  • Phone: 336-760-3446
  • Fax: 336-765-7710
Mailing address:
  • Phone: 336-760-3446
  • Fax: 336-765-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4512
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number4512
License Number StateNC

VIII. Authorized Official

Name: MR. NICK ELLEDGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 336-679-8852