Provider Demographics
NPI:1225011455
Name:HOLYFIELD, DEREK (PHARM D)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:HOLYFIELD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:TN
Mailing Address - Zip Code:38330-0265
Mailing Address - Country:US
Mailing Address - Phone:731-696-3288
Mailing Address - Fax:731-692-4219
Practice Address - Street 1:137 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:TN
Practice Address - Zip Code:38330-1815
Practice Address - Country:US
Practice Address - Phone:731-692-3578
Practice Address - Fax:731-692-4219
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist