Provider Demographics
NPI:1184050775
Name:GIPSON, HOLLY SMITH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:SMITH
Last Name:GIPSON
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 1:2075 LAKEFRONT DR APT 1802
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-1421
Mailing Address - Country:US
Mailing Address - Phone:256-655-0950
Mailing Address - Fax:
Practice Address - Street 1:4851 WHITESBURG DR SE
Practice Address - Street 2:STE B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1626
Practice Address - Country:US
Practice Address - Phone:256-650-2396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist