Provider Demographics
NPI:1275974347
Name:MOREAU, HOLLY NEAL
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:NEAL
Last Name:MOREAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 NW 33RD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1940
Mailing Address - Country:US
Mailing Address - Phone:305-908-3526
Mailing Address - Fax:
Practice Address - Street 1:8300 NW 33RD ST STE 400
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1940
Practice Address - Country:US
Practice Address - Phone:305-908-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist