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General NPI Number Information
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NPI Number | 1881915957
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Entity Type | Organization
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Legal Business Name | HOLLADAY PHARMACEUTICAL LLC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 406 N STATE ST
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City | OREM
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State | UT
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Zip | 84057-3802
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Country | US
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Telephone | 801-434-7670
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Fax | 801-434-7669
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Provider Business Mailing Address
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Address Line | 69 E HUDSON DR
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City | ELK RIDGE
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State | UT
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Zip | 84651-5598
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Country | US
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Telephone | 801-434-7670
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Fax | 801-434-7669
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Authorized Official
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Title or Position | MANAGER
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Name | PENNY JO GUSTAFSON
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Credential |
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Telephone | 801-756-4021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 7686605-1703
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License Number State | UT
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