Healthcare Provider Details

I. General information

NPI: 1194032938
Provider Name (Legal Business Name): KYLE HOLLOWAY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 BUENA VISTA DR SE SUITE 1400
ALBUQUERQUE NM
87106-4260
US

IV. Provider business mailing address

2501 BUENA VISTA DR SE SUITE 1400
ALBUQUERQUE NM
87106-4260
US

V. Phone/Fax

Practice location:
  • Phone: 505-923-5504
  • Fax: 505-923-6922
Mailing address:
  • Phone: 505-923-5504
  • Fax: 505-923-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007480
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: