Provider Demographics
NPI:1821031105
Name:HOLLAND PHARMACY INC
Entity Type:Organization
Organization Name:HOLLAND PHARMACY INC
Other - Org Name:HOLLAND PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND SP
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-537-2822
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080-0021
Mailing Address - Country:US
Mailing Address - Phone:716-537-2822
Mailing Address - Fax:716-537-2105
Practice Address - Street 1:19 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9509
Practice Address - Country:US
Practice Address - Phone:716-537-2822
Practice Address - Fax:716-537-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0089543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00584487Medicaid
2057237OtherPK
0657300001Medicare NSC