Provider Demographics
NPI:1013063916
Name:HOLLY PHARMACY INC
Entity type:Organization
Organization Name:HOLLY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREAS
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-486-8606
Mailing Address - Street 1:31 N BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17065-1302
Mailing Address - Country:US
Mailing Address - Phone:717-486-5321
Mailing Address - Fax:
Practice Address - Street 1:31 N BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17065-1302
Practice Address - Country:US
Practice Address - Phone:717-486-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11238470002Medicaid
PA11238470002Medicaid