Provider Demographics
NPI:1043814130
Name:VAGUE, HOLLY A (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:VAGUE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 MONTCLAIR RD
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2409
Mailing Address - Country:US
Mailing Address - Phone:205-592-2424
Mailing Address - Fax:
Practice Address - Street 1:1675 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2409
Practice Address - Country:US
Practice Address - Phone:205-592-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist