Provider Demographics
NPI:1568652295
Name:HOLLINGSWORTH, JAMES WARREN (PD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WARREN
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 370
Mailing Address - Street 2:
Mailing Address - City:GLOSTER
Mailing Address - State:MS
Mailing Address - Zip Code:39638
Mailing Address - Country:US
Mailing Address - Phone:601-225-7907
Mailing Address - Fax:601-225-7906
Practice Address - Street 1:434B N CAPTAIN GLOSTER DR
Practice Address - Street 2:
Practice Address - City:GLOSTER
Practice Address - State:MS
Practice Address - Zip Code:39638-3401
Practice Address - Country:US
Practice Address - Phone:601-225-7907
Practice Address - Fax:601-225-7906
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-6051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist