Provider Demographics
NPI:1972289130
Name:HOLLAND, MALLORY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:HOLLAND
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 1:25400 FORT MEIGS RD APT 18
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2231
Mailing Address - Country:US
Mailing Address - Phone:419-701-8130
Mailing Address - Fax:
Practice Address - Street 1:1200 MEDICAL CENTER PKWY STE E
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1921
Practice Address - Country:US
Practice Address - Phone:419-383-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032370821835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care