Provider Demographics
NPI:1770256125
Name:GRABER, HOLLY LYNN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:GRABER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2699 KUTZTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1915
Mailing Address - Country:US
Mailing Address - Phone:267-374-2802
Mailing Address - Fax:
Practice Address - Street 1:931 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1603
Practice Address - Country:US
Practice Address - Phone:215-679-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist