Provider Demographics
NPI:1285024323
Name:HOLLOWAY PHARMACY LLC
Entity Type:Organization
Organization Name:HOLLOWAY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:318-466-3113
Mailing Address - Street 1:12805 HIGHWAY 28 E
Mailing Address - Street 2:STE A
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-0734
Mailing Address - Country:US
Mailing Address - Phone:318-466-3113
Mailing Address - Fax:318-466-1441
Practice Address - Street 1:12805 HIGHWAY 28 E
Practice Address - Street 2:STE A
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-0734
Practice Address - Country:US
Practice Address - Phone:318-466-3113
Practice Address - Fax:318-466-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007057-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7564500001Medicare NSC