Provider Demographics
NPI:1922602903
Name:ROUPE, HOLLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ROUPE
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 1:2403 W BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2523
Mailing Address - Country:US
Mailing Address - Phone:205-746-8950
Mailing Address - Fax:
Practice Address - Street 1:8422 NAVARRE PKWY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-6904
Practice Address - Country:US
Practice Address - Phone:850-936-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist