Provider Demographics
NPI:1164711065
Name:HOLLEY, WILLIAM KEITH (PHD,RPH)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEITH
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:PHD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NC 102 W
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-8792
Mailing Address - Country:US
Mailing Address - Phone:252-746-3026
Mailing Address - Fax:252-746-7953
Practice Address - Street 1:140 NC 102 W
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-8792
Practice Address - Country:US
Practice Address - Phone:252-746-3026
Practice Address - Fax:252-746-7953
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist