Provider Demographics
NPI:1508343336
Name:HOLLEY, JOHN NEAL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:NEAL
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-1775
Mailing Address - Country:US
Mailing Address - Phone:334-393-0086
Mailing Address - Fax:334-393-0206
Practice Address - Street 1:612 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1775
Practice Address - Country:US
Practice Address - Phone:334-393-0086
Practice Address - Fax:334-393-0206
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL183049Medicaid