Provider Demographics
NPI:1568240133
Name:HARLAN, HOLLY JO
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JO
Last Name:HARLAN
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 1:22424 HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MO
Mailing Address - Zip Code:65281-2604
Mailing Address - Country:US
Mailing Address - Phone:660-676-7404
Mailing Address - Fax:
Practice Address - Street 1:7101 COLLEGE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2083
Practice Address - Country:US
Practice Address - Phone:888-799-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-117759183500000X
MO2023029940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist