Provider Demographics
NPI:1073619284
Name:HOLLOWAY, KEVIN W (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:W
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20500 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4115
Mailing Address - Country:US
Mailing Address - Phone:248-799-6884
Mailing Address - Fax:
Practice Address - Street 1:20500 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4115
Practice Address - Country:US
Practice Address - Phone:248-799-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist