Provider Demographics
NPI:1619979242
Name:HOLLIS, MARY ELLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3114
Mailing Address - Country:US
Mailing Address - Phone:561-265-0909
Mailing Address - Fax:
Practice Address - Street 1:3599 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9404
Practice Address - Country:US
Practice Address - Phone:954-333-5215
Practice Address - Fax:954-333-5225
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist