Provider Demographics
NPI:1497937593
Name:PROSSER, HOLLY RUTH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:RUTH
Last Name:PROSSER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6993 IROQUOIS DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-7981
Mailing Address - Country:US
Mailing Address - Phone:716-625-8970
Mailing Address - Fax:
Practice Address - Street 1:459 S TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5506
Practice Address - Country:US
Practice Address - Phone:716-433-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist