Provider Demographics
NPI:1396021994
Name:HOLSHOUSER, MARK HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HOWARD
Last Name:HOLSHOUSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 NC HIGHWAY 801 N
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-6704
Mailing Address - Country:US
Mailing Address - Phone:336-940-2193
Mailing Address - Fax:
Practice Address - Street 1:1510 NC HIGHWAY 801 N
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6704
Practice Address - Country:US
Practice Address - Phone:336-940-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist