Provider Demographics
NPI:1184757890
Name:MCCORMICK, HOLLY HERRIN (PHARMD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:HERRIN
Last Name:MCCORMICK
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 1:1317 SW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3225
Mailing Address - Country:US
Mailing Address - Phone:352-363-0378
Mailing Address - Fax:
Practice Address - Street 1:8445 SW HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9607
Practice Address - Country:US
Practice Address - Phone:352-854-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41389183500000X
GARPH021743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050140Medicare ID - Type Unspecified