Provider Demographics
NPI:1417550856
Name:RANDOLPH, HOLLY RENEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:RENEE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 FM 17
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140
Mailing Address - Country:US
Mailing Address - Phone:903-274-5661
Mailing Address - Fax:
Practice Address - Street 1:145 N 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-2040
Practice Address - Country:US
Practice Address - Phone:903-873-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist