Healthcare Provider Details

I. General information

NPI: 1710544002
Provider Name (Legal Business Name): CHRISTIANE AALIYAH HOLLOWAY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11290 W BROAD ST
GLEN ALLEN VA
23060-5815
US

IV. Provider business mailing address

6779 DORSEY RD APT 147
ELKRIDGE MD
21075-7452
US

V. Phone/Fax

Practice location:
  • Phone: 804-360-8912
  • Fax: 804-588-4540
Mailing address:
  • Phone: 804-229-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202218733
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number25924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: