Provider Demographics
NPI:1073035838
Name:POGUE, HOLLI LECROY (PHARM D)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:LECROY
Last Name:POGUE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:HOLLI
Other - Middle Name:RENEE
Other - Last Name:LECROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 MONTCLAIR RD
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1560 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2230
Practice Address - Country:US
Practice Address - Phone:205-595-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist