Provider Demographics
NPI:1821723792
Name:HOLLOWAY, BAILEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:HOLLOWAY
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 1:208 STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:FOREMAN
Mailing Address - State:AR
Mailing Address - Zip Code:71836-9029
Mailing Address - Country:US
Mailing Address - Phone:318-680-8889
Mailing Address - Fax:
Practice Address - Street 1:3520 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0705
Practice Address - Country:US
Practice Address - Phone:903-716-7110
Practice Address - Fax:903-716-7111
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty