Provider Demographics
NPI:1780031278
Name:TERRY, HOLLY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32456-0236
Mailing Address - Country:US
Mailing Address - Phone:850-370-0889
Mailing Address - Fax:
Practice Address - Street 1:110 N 35TH ST
Practice Address - Street 2:
Practice Address - City:MEXICO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32456-0236
Practice Address - Country:US
Practice Address - Phone:850-370-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist