Provider Demographics
NPI:1679187652
Name:HOLDER, JANESSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:
Last Name:HOLDER
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 1:27 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1762
Mailing Address - Country:US
Mailing Address - Phone:413-485-8283
Mailing Address - Fax:
Practice Address - Street 1:54 CENTER SQ
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2446
Practice Address - Country:US
Practice Address - Phone:413-526-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist