Provider Demographics
NPI:1194032938
Name:HOLLOWAY, KYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BUENA VISTA DR SE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4260
Mailing Address - Country:US
Mailing Address - Phone:505-923-5504
Mailing Address - Fax:505-923-6922
Practice Address - Street 1:2501 BUENA VISTA DR SE
Practice Address - Street 2:SUITE 1400
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4260
Practice Address - Country:US
Practice Address - Phone:505-923-5504
Practice Address - Fax:505-923-6922
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist