MEDICARE: DR. ANDREA THERESA HOLLIDAY PHARMD

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	63732	TX

General Provider Information

NPI Number	:	1871262329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA THERESA HOLLIDAY PHARMD

Provider Business Mailing Address
First Line	:	1700 CEDAR SPRINGS RD APT 2012
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-1224
Country	:	US
Telephone Number	:	901-289-3972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 CEDAR SPRINGS RD APT 2012
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-1224
Country	:	US
Telephone Number	:	901-289-3972
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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