Provider Demographics
NPI:1245765049
Name:HOLLOWAY, JAY (PHARMD, AAHIVP)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:PHARMD, AAHIVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 TAFT AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5681
Mailing Address - Country:US
Mailing Address - Phone:913-233-6967
Mailing Address - Fax:
Practice Address - Street 1:831 E AVENUE K
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4712
Practice Address - Country:US
Practice Address - Phone:661-942-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-29
Last Update Date:2023-08-17
Deactivation Date:2022-09-14
Deactivation Code:
Reactivation Date:2022-10-12
Provider Licenses
StateLicense IDTaxonomies
NE16227183500000X
CO21583183500000X
CA85497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist