Provider Demographics
NPI:1710400643
Name:HOLLEYMAN, MOSES HALCON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:HALCON
Last Name:HOLLEYMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 TUSCULUM BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4249
Mailing Address - Country:US
Mailing Address - Phone:423-636-1344
Mailing Address - Fax:
Practice Address - Street 1:1355 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4249
Practice Address - Country:US
Practice Address - Phone:423-636-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist