Provider Demographics
NPI:1497000640
Name:WHITLOW, HOLLY MOORE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MOORE
Last Name:WHITLOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:RADFORD
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1201 BROAD ROCK BOULEVARD
Mailing Address - Street 2:SERVICE 119
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249
Mailing Address - Country:US
Mailing Address - Phone:804-675-5000
Mailing Address - Fax:804-360-1082
Practice Address - Street 1:1201 BROAD ROCK BOULEVARD
Practice Address - Street 2:SERVICE 119
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-360-1082
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist