Provider Demographics
NPI:1407572415
Name:HOLLAND, DIANA CECIL
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CECIL
Last Name:HOLLAND
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 1:221 HABERSHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28457-3305
Mailing Address - Country:US
Mailing Address - Phone:276-698-8441
Mailing Address - Fax:
Practice Address - Street 1:4600 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5149
Practice Address - Country:US
Practice Address - Phone:910-392-4549
Practice Address - Fax:401-269-4684
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist