Provider Demographics
NPI:1346657152
Name:HOLLAND, JESSIE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 S CORONADO RD
Mailing Address - Street 2:APARTMENT 1154
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1390
Mailing Address - Country:US
Mailing Address - Phone:478-230-9809
Mailing Address - Fax:
Practice Address - Street 1:2440 S IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-7652
Practice Address - Country:US
Practice Address - Phone:480-288-0428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist