Provider Demographics
NPI:1184301095
Name:HOLMQUIST, HOLLY ANN
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:HOLMQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLYANN
Other - Middle Name:
Other - Last Name:HOLMQUIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14575 SHANER AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-9558
Mailing Address - Country:US
Mailing Address - Phone:616-255-5943
Mailing Address - Fax:
Practice Address - Street 1:10772 W CARSON CITY RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-9141
Practice Address - Country:US
Practice Address - Phone:616-754-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5351016908183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician