Healthcare Provider Details

I. General information

NPI: 1790706810
Provider Name (Legal Business Name): SUSAN LYNN HOLLY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 KIRMAN AVE PHARMACY
RENO NV
89502-0993
US

IV. Provider business mailing address

2730 SUNLINE DR
RENO NV
89523-2109
US

V. Phone/Fax

Practice location:
  • Phone: 775-785-7285
  • Fax:
Mailing address:
  • Phone: 775-787-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number15067
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: