MEDICARE: ALEXIS RENEE HOLLOMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202221753	VA

General Provider Information

NPI Number	:	1255108585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS RENEE HOLLOMAN

Provider Business Mailing Address
First Line	:	1106 N 20TH ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5108
Country	:	US
Telephone Number	:	843-245-2945
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 N 25TH ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5243
Country	:	US
Telephone Number	:	804-537-0103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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