Provider Demographics
NPI:1275838377
Name:HOLLOWAY, CHARLES FARRELL III (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FARRELL
Last Name:HOLLOWAY
Suffix:III
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 NW 35TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6026
Mailing Address - Country:US
Mailing Address - Phone:734-238-8249
Mailing Address - Fax:
Practice Address - Street 1:4365 NW 35TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6026
Practice Address - Country:US
Practice Address - Phone:734-238-8249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39415183500000X
KY012342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist