Healthcare Provider Details

I. General information

NPI: 1063823318
Provider Name (Legal Business Name): HOLLY COPELAND PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY HENDRICK

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 NEW BOSTON RD
TEXARKANA TX
75501-2819
US

IV. Provider business mailing address

4000 NEW BOSTON RD
TEXARKANA TX
75501-2819
US

V. Phone/Fax

Practice location:
  • Phone: 903-831-3023
  • Fax: 903-831-5744
Mailing address:
  • Phone: 903-831-3023
  • Fax: 903-831-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: