Provider Demographics
NPI:1760025274
Name:HOLIDAY ISLAND PHARMACY, LLC
Entity Type:Organization
Organization Name:HOLIDAY ISLAND PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-425-7814
Mailing Address - Street 1:2 FOREST PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY ISLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9229
Mailing Address - Country:US
Mailing Address - Phone:479-239-2121
Mailing Address - Fax:479-239-2122
Practice Address - Street 1:2 FOREST PARK DR STE A
Practice Address - Street 2:
Practice Address - City:HOLIDAY ISLAND
Practice Address - State:AR
Practice Address - Zip Code:72631-9229
Practice Address - Country:US
Practice Address - Phone:479-239-2121
Practice Address - Fax:479-239-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy