Healthcare Provider Details

I. General information

NPI: 1881480366
Provider Name (Legal Business Name): HOLLY ANN ANDERSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 2ND AVE SW
MIAMI OK
74354-6830
US

IV. Provider business mailing address

200 2ND AVE SW
MIAMI OK
74354-6830
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-7622
  • Fax: 918-540-7842
Mailing address:
  • Phone: 918-540-7622
  • Fax: 918-540-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number18905
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18905
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: