Healthcare Provider Details

I. General information

NPI: 1811535057
Provider Name (Legal Business Name): HOLLY HARALSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 AVENUE E
CISCO TX
76437-3446
US

IV. Provider business mailing address

1010 AVENUE E
CISCO TX
76437-3446
US

V. Phone/Fax

Practice location:
  • Phone: 254-442-2587
  • Fax: 254-442-2251
Mailing address:
  • Phone: 254-442-2587
  • Fax: 254-442-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47298
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: