Provider Demographics
NPI:1639793276
Name:HOLLEY-NAVARRE PHARMACY & GIFTS LLC
Entity Type:Organization
Organization Name:HOLLEY-NAVARRE PHARMACY & GIFTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:850-359-6619
Mailing Address - Street 1:8440 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-9284
Mailing Address - Country:US
Mailing Address - Phone:850-359-6619
Mailing Address - Fax:850-684-1049
Practice Address - Street 1:8440 NEVADA ST.
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566
Practice Address - Country:US
Practice Address - Phone:850-359-6619
Practice Address - Fax:850-684-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108865500Medicaid