Provider Demographics
NPI:1093407017
Name:HOLLABAUGH, MARIAH ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:ELIZABETH
Last Name:HOLLABAUGH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:MARIAH
Other - Middle Name:ELIZABETH
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1500 NORTH OAKLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613
Mailing Address - Country:US
Mailing Address - Phone:417-328-6684
Mailing Address - Fax:417-328-7018
Practice Address - Street 1:1500 NORTH OAKLAND AVENUE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-328-6684
Practice Address - Fax:417-328-7018
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130247561835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy