Provider Demographics
NPI:1790429579
Name:HOLLINGSWORTH, DAPHNE BAILEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:BAILEY
Last Name:HOLLINGSWORTH
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 1:2724 SOPHIE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-9128
Mailing Address - Country:US
Mailing Address - Phone:740-645-0994
Mailing Address - Fax:
Practice Address - Street 1:546 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9053
Practice Address - Country:US
Practice Address - Phone:406-297-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-38463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist